Value of pill/strip counts

[hedwards]

We are physicians, not law enforcement, and the "war and drugs" is not the solution, it is most of the problem. I do random saliva drug screens. Very easy to observe, and cost ~$10. The only thing you'll discover with pill/film counts is the few really stupid patients in your practice. You can count, but you don't have a clue what happens to them after you count them. Pill counts are a Counterproductive hoax. Furthermore, pharmacists are trained to count pills. It would be outside my area of expertise to do this, then there are the stories of patients who accuse the "counters" of stealing their drug.

DON'T COUNT DRUGS!

[Jeremy K]

@sslonim:
Thanks for the viewpoint. I, too, do not do 'observed' urines, but I wonder about those as well. I think I'll start a thread about that, please consider contributing to it.

[Dave]

If you do not do observed urine collections on at least some of your patients, you will certainly be deceived by more than you think. Some of them are remarkably innovative, and one woman stands out as the queen of deception. She had connected an elongated, spiral red balloon to a metal stopcock, which would allow a clean urine sample stored in the balloon to be released with a slight finger twist of 45 degrees on the stopcock. This apparatus was inserted into the vagina so that only close observation would detect her finger twist to let the urine flow into the cup. The urine would pass the temperature test and all the drug tests, as long as there was some bup in it.

[sslonim]

I understand the thinking/need for pill counts, drug testing etc. but I'll just say that I consider the people I prescribe buprenorhine to as my patients ... not the enemy. I use drug tests, pill counts as pieces of data along with all the other information I have on a patient - I don't rely on one item alone and don't go the extremes mentioned such as matching bar codes to pharmacy records.
(I don't do observed urines and my lab form for recording urine testing results specifically says this is not for legal purposes.)