Validation of a Community Pharmacy-based Prescription Drug Monitoring Program Risk Screening Tool (PHARMSCREEN) (NIH HEAL Initiative) (CTN-0093). Fatal overdose deaths involving prescription opioids, heroin, and synthetic opioids continued to increase across the United States—increasing in 35 states from 2013 to 2017. Given these persistent trends in adverse opioid-related outcomes across the country, it was critical to identify those who were at risk, deliver appropriate care to help prevent progression to more severe opioid-related outcomes, and provide referral and treatment resources to individuals with opioid use disorder (OUD). Therefore, it was necessary to expand the continuum of care to health care settings that had previously been underutilized. One such underutilized resource for addressing the opioid epidemic was community pharmacies. The most important clinical tool pharmacists had available to identify possible misuse of opioid medications was the prescription drug monitoring program (PDMP), which captured patient-level prescription dispensing information to inform monitoring, dispensing decisions, and potential intervention. These tools were available in all U.S. states and had the potential to enable pharmacists to identify patients at risk for opioid-related adverse events, such as addiction and overdose. In light of the continued escalation of the opioid epidemic nationally, combined with the promising opportunities afforded by further inclusion of community pharmacy settings in engaging patients with opioid-related risk, it was important to evaluate whether PDMP risk metrics correlated with clinically validated opioid risk tools and whether clinically meaningful risk cutoffs existed for PDMP risk metrics.