[Verse 1]
Pull up to the clinic, got a patient on the table
Chronic pain is real but the risk ain't always stable
Before you write that script you gotta measure what you're facin'
ORT or SOAPP-R gonna start the conversation
Opioid Risk Tool — five domains, score it clean
Family history, personal use, age, psych, and what abuse means
Low risk zero to three, moderate hits four to seven
Eight and above, that's high risk, recalibrate your heaven
SOAPP-R got twenty-four items, self-report extended
DIRE score for primary care, resources and intended
COMM watch for aberrant behavior while they're on the medicine
Every tool's a different lens, combine 'em, don't be questioning
[Chorus]
Check the PDMP, check the urine cup
Immunoassay screens, confirmatory backs it up
ORT, SOAPP, DIRE — score before you sign
Naloxone co-prescribe when the risk starts to climb
False positive, false negative — don't read it blind
Metabolite cascades gonna blow your mind
Dose, co-prescriptions, apnea, renal decline
Assess the risk or cross that patient-safety line
[Verse 2]
Log into the PDMP before you even touch that pad
Multiple prescribers, pharmacy hopping — that's flagged bad
Now the urine cup arrives, immunoassay's the gate
Cheap and fast but antibody cross-reactions make mistakes
Quinolones fake positive opiates, poppy seeds too
Rifampin flips morphine screens — the chemistry will fool you
Confirmatory testing — mass spec don't lie
Quantify the molecule, identify with precision high
Expected metabolite absent? Patient's not compliant
Unexpected compound present? Time for an alliance
Codeine metabolizes morphine — that's a normal trail
Hydromorphone from hydrocodone at low levels, not betrayal
[Chorus]
Check the PDMP, check the urine cup
Immunoassay screens, confirmatory backs it up
ORT, SOAPP, DIRE — score before you sign
Naloxone co-prescribe when the risk starts to climb
False positive, false negative — don't read it blind
Metabolite cascades gonna blow your mind
Dose, co-prescriptions, apnea, renal decline
Assess the risk or cross that patient-safety line
[Verse 3]
Now let's catalog the overdose risk, engrave it in your skull
High morphine milligram equivalents — that bucket stays full
Ninety MME daily doubles down the danger zone
Benzos plus opioids — respiratory arrest alone
Sleep apnea unmanaged, oxygenation already thin
Add an opioid on top of that, hypoxia seeping in
Renal disease stacks active metabolites sky-tall
Hepatic failure wrecks the CYP, clearance starts to crawl
Prior overdose the single loudest signal screaming red
Mental illness, substance use disorder — factor in what's said
Co-occurring buprenorphine doesn't cancel out the threat
Stratify every visit — risk ain't static, don't forget