Identifying controlled substance patterns of utilization requiring evaluation using administrative claims data.

Objectives: To develop a systems approach to identify, for further evaluation, patients with potential controlled substance misuse or mismanagement using software queries applied to administrative health claims data.

Study Design: Retrospective validation of the system using insurance claims.

Patients And Methods: Data from administrative health claims databases representing nearly 7 million individuals younger than 65 years were used by multidisciplinary expert panels to develop and validate controlled substance patterns of utilization requiring evaluation (CS-PURE) criteria.