Examining the effects of pill counts on treatment retention in buprenorphine maintenance therapy

Introduction: Buprenorphine is internationally recognized as an effective treatment for Opioid Use Disorder (OUD). Pill counting, a quantitative assessment of medication supply to monitor prescription medication adherence, is often recommended to monitor buprenorphine adherence. However, there is little evidence to support pill counting or examine its impact on addiction treatment. This retrospective review seeks to examine retention in treatment before and after implementation of a novel pill count protocol in outpatient substance use treatment. Methods: This observational retrospective cohort study consisted of patients receiving buprenorphine or buprenorphine/naloxone for treatment of OUD as part of an outpatient university-affiliated substance use treatment program in the United States. Patients seen prior to the introduction of pill counts (n = 103) were compared to patients (n = 107) who had a pill count performed after the introduction of pill counts. Results: Retention in treatment was higher after pill count implementation, but the statistical evidence was not consistent across analyses. The incidence of an inappropriate pill count was 36.4%. No significant difference in retention in treatment was found between those with appropriate counts and inappropriate counts (94.8% versus 95.5%, p = 0.87). The most common clinician response to an inappropriate pill count was closer follow up (43.6%). We describe our pill count protocol as a prototype. Conclusions: The findings from this study show inconsistent statistical support for a positive association between buprenorphine pill counts and retention in OUD treatment. A prototype pill count may allow for standardization and validation of this commonly performed yet poorly understood practice.