It should work in a similar way to us here in Australia. Here, there would be two possibilities.
1) The pharmacy (a staff member, probably) is swiping medications from your bottles
OR
2) the drug company is short-loading the pill containers.
I would put your concerns in writing to the pharmacy, point out your long relationship with them, also point out your continuity of care (not drug-seeking behaviour) and make it clear - you do not want to take this further if you don't have to, but you do have responsibilities to report your concerns higher up, because sure as eggs, you will not be the only patient this is happening to.
Also tell your doctor what is happening. Your doctor may have other patients using the same pharmacy, and can discreetly check with them if there are issues.
Next - at the same time, actually - call around, anonymously (at least, not yet divulging the name of the pharmacy until you give them a chance to make this right) to find out who you report this to and what the consequences are. For us here, the Pharmacy Guild would be one place, as would our government body responsible for overseeing the regulated supply of strong pain medications.
I also am a long-termer on strong pain medications. Mine come in foil packs so counting pills is not an issue. Each foil has ten tablets or capsules in it. My prescription is for a fixed number. Sometimes the pharmacist doesn't have enough to fill my prescription, and tells me. He writes on the box (and makes a note) that he owes me a certain amount.
The problem here is, when we make a fuss we get labelled as drug-seeking. It's a nasty tactic which if applied to someone who is actually an addict, will shut them up. But it also muzzles those of us afraid of being labelled. You can't win./ But if you have your specialists on side to back you up (they know how often they write prescriptions for you) then it's easier to stand up for yourself.
One more nastier possibility occurs to me - could someone be removing pills from your supply, after they come home? Or perhaps in transit from pharmacy to you? You need to be able to say with certainty that this is not happening, because the accusation will be made, if you begin to make waves. But your supply of pain medications is being compromised, so you need to do/say something. I do know how that can make you anxious, when the alternative is uncontrolled pain.
Incidentally, I'm dealing with (I think) similar issues of disbelief (or at least scepticism) from my GP. She's the newest member of my health care team, my previous GP began to specialise about four years ago. But she has seen me through the liver crisis that forced my weight loss (demonstrating I have self-discipline), through whooping cough, my cancer diagnosis and she also writes the prescriptions for my pain medications with a letter justifying it form the pain specialist. She also has my full medical file form the previous GP. She should know me. When I started seeing her, my morphine dosage was 140 mg a day. A rheumatologist put me on prednisone which allowed me to cut back to 100 mg a day but I didn't want to stay on prednisone, I felt it was a bad exchange. Going off the prednisone, I had to increase morphine back, but managed to keep it at 120 mg a day. I take it as a once a day sustained release dose, taking it in the morning, and it has prevented the severe crippling headaches I used to get - a fringe benefit of managing my other pain.
Then for whatever reason I don't know, I found I could cut back a little more, so I did. I saw my pain specialist in early March and told him I had managed to cut back to 100 mg a day from December. But December/January/February prescriptions were a problem. The GP did all the right things, rang the government body to get the paperwork organised, did exactly as they said (I was in the room, heard the phone call) dated everything right, posted off a special prescription to cover the period she would be out of the country and unable to re-supply me. The prescription was posted to my pharmacist for dispensing. But first I had my regular monthly script dispensed. When the special government one arrived a few weeks later, I had it dispensed. But there was apparently a glitch. "No problem, I'll sort it out, said the locum pharmacist. I found out later he had a problem because both prescriptions had the same date - even though, in this case, the government had specifically said to do it that way. But they cancelled my first script retrospectively, then issued it retrospectively as the first of my two government ones. Then issued what I thought was my FIRST government script, as my second. So when I went back a month later, I had no script. I had to urgently organise to see my GP as soon as she arrived back in the country, and I was almost out of pills. I had only coped, because I had a backlog accumulated over the years.
Now my problem began and from here, I think my GP no longer trusts me. There was I, a month too early, asking for more pills. Worse, she had to talk to the government people about it and I had to explain to both sets of people why I was back a month too early. I told them what the pharmacist had told me and had a hard time convincing them I was not lying. I tried to ring the pharmacist - he was at a funeral, it turned out (one I would have gone to but I had to see the doctor, didn't i!) and had left the phone unattended. It made me look even more shifty.
I got my script, but at 100 mg a day. The months I had been on prednisone in 2009, my GP had insisted on writing scripts for the 140 mg a day even though I was not taking that much (hence my backlog). Now, a day after I reported having cut back to 100 mg a day, she would not write the script for 120 mg a day even though from past experience the chances are high I would have to go back to the higher dose. Thankfully I didn't have to.
When I saw my pain specialist in early March I told him I had cut back from 120 mg to 100 mg since December. He was pleased and surprised. Ironically later that day I realised I was late taking my pain medications and was not suffering too much, so I decided to chance it and cut back again. My capsules can be opened, the stuff inside is in little beads and the capsules have lines on the clear gelatine sides. So I have been literally cutting my medications. it takes ingenuity. Since early March I have cut back from 100 mg to 80 mg, then 70 mg and today cut further to 60 mg.
I saw my GP yesterday for my monthly prescription. She was friendly, but increasingly treating me as an addict in withdrawal. "It will be good to get you entirely off this by the end of the year," she said.
"At this rate it will be sooner than the end of the year, but frankly I think my drop in medications may have almost reached a limit. I am still in pain, it's just that I am managing on less. I have tried to do this before without this degree of success. This is not willpower; it is me taking advantage of a change in my pain levels, that is all."
I don't think she believes me, and now I think she believes I've been indulging myself with this for years and have now decided to give up my drugging ways.
I think I've done flamin' brilliantly to cut my morphine dose in half since December. All by myself, too. Mind you, having to take my capsules apart is awkward - the little beads inside can fall and scatter. On Monday I had to manage while at the airport. There I was with a palmful of morphine beads in Sydney Airport, trying to measure them back into a gelatine capsule. Sweaty palms can turn the capsule to unusable jelly. I was relying on mother in law to stay with me while I did this, because her walking frame is a steady work platform for this task and if she could hold my handbag for me, I had less risk of dropping the stuff everywhere and wasting an entire day's dose. But just at the critical moment she decided to toddle off to see how sis-in-law's check-in was going. There I was on my own, minding sis-in-law's hand luggage, my handbag at risk of being grabbed, while I was trying to measure a palmful of morphine beads. Thankfully there were no sniffer dogs around!
So now I've done what I think is a really amazing thing which I think demonstrates my determination to NOT abuse my medications, I am dealing with more obstacles and more scepticism from my GP. Plus hassles from the pharmacist. Or maybe because of hassles from my pharmacist.
You can bet that my next pain specialist appointment will be very interesting indeed! VERY interesting... I'm hoping he includes in his letter to my GP, his concern that I not be treated with suspicion because I have proven to him that I am not abusing my medications.
I really get cranky with doctors who don't understand pain medications. Like the idiot who put me on prednisone for six months, thinking it was preferable to morphine. It took both the pain specialist and the neurologist to argue with him and in the end I had to refuse to take prednisone any more. It is highly possible that the prednisone reduced my immunity to the point where I caught whooping cough, and also allowed my cancer to grow. I know which treatment is preferable!
So hang in there, I do get how you feel about this. You should not have to feel insecure about your pain medications.
Marg
