Original title: Examining the effects of pill counts on treatment retention in buprenorphine maintenance therapy
Jack Larsen, Patrick Kenney, Tonya Milam, Joyce Troxler +2 · September 2026
Buprenorphine is a medication that helps treat opioid use disorder. Doctors often count a patient's leftover pills to see if they take their doses correctly. Even though clinics use this method widely, very little evidence shows whether counting pills actually helps people stay in treatment. Researchers studied an outpatient clinic before and after it started using a new pill count system. Clinic staff counted patients' remaining medicine to check their supply against what they should have left. The researchers found that treatment retention went up after the clinic started counting pills, but the statistical evidence was not consistent across all analyses. Over a third of the counts were inappropriate, meaning the pill total was off. When this happened, doctors most often chose to monitor the patient more closely. Patients with inappropriate counts stayed in treatment at essentially the same rate as those with proper counts.
Imagine you are trying to improve your free-throw shooting in basketball. You decide to count how many shots you take each practice. But sometimes you forget to record a few, and other days you count differently. Counting seems logical, but it doesn't tell you if you are actually making more baskets. In this paper, doctors count leftover pills to see if patients are taking their medication, but the counting itself is often flawed and doesn't clearly help patients stay in treatment.
Clinics routinely count leftover pills to check if patients are taking buprenorphine as prescribed, but this common practice has little evidence behind it. This study suggests that counting may not actually help patients stay in treatment longer. In addiction care, where every effort should be backed by proof, these findings challenge a widely used procedure and point toward the need for better monitoring methods.
The study is observational and retrospective, so it cannot prove that pill counts caused changes in retention. Results were inconsistent across statistical analyses. It was conducted at a single university-affiliated clinic, so findings may not apply to other settings. The protocol described is a prototype, not a validated standard. The study also does not measure other important outcomes like illicit drug use or patient satisfaction.
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Examining the effects of pill counts on treatment retention in buprenorphine maintenance therapy — Jack Larsen, Patrick Kenney, Tonya Milam et al. — Drug and alcohol dependence reports — doi:10.1016/j.dadr.2026.100478
Abstract licence: CC BY
Explanation generated by Synthesis from the abstract — it is not the original paper.