The noted benefit of using the proposed metrics is that they provide a tool to State-level institutions that have the statutory authority and responsibility to identify and investigate individuals employing unusual and questionable prescription practices. In North Carolina, where the validity of the metrics was tested, these State institutions are the State Bureau of Investigation and the Medical Board. Each institution can select the particular metric it believes is most likely to identify prescription providers that warrant investigation. The authors acknowledge that the proposed metrics constitute only an initial screen, meaning that a substantial amount of work must be done by the authorities responsible for identifying prescribers who warrant attention. In the current study, the focus was on prescribers who were temporally linked by their prescribing records to individuals who died from an overdose of the prescribed drug. Such data, however, may be inconsistent, and the emergency services available to reverse overdoses may affect mortality rates in rural areas. None of the data sources should be considered a gold standard against which the sensitivity and specificity of the algorithms may be judged; however, there is value in assessing their concurrent validity. 2 tables, 2 figures, and 46 references