Substance use disorders (SUD), and especially opioid abuse disorder (OUD) with resulting overdose-related deaths, constitute one of the most significant health crises of modern times. The use of illicit synthetic opioids, heroin and misuse of prescription pain medication are reaching epidemic proportions without respect to race, ethnicity or age. These disorders are altering medicine’s practice forever and modern hospice and palliative medicine (HPM) practice.  Substance use and OUD occur among seriously ill patients who receive palliative care or hospice services and may be higher than the general population. Surveys of palliative care practitioners suggest it is common to encounter or manage behaviors concerning opioid misuse. Palliative care clinicians find themselves caring for more patients with OUD, given that this patient population is at high risk for life-limiting illnesses. Palliative care clinicians must balance using controlled substances for symptom control and potentially triggering harmful outcomes using controlled substances in a susceptible population. Managing the patient with OUD in the hospice setting is now considered a core skill for palliative care physicians, but there is a lack of guidance to help clinicians in this area to enhance the skill set, a panel of pain management experts and addiction specialists will, by way of case presentation, didactics, and audience participation, enable attendees to 
1. Define the current role of methadone, buprenorphine, buprenorphine-naloxone, and intramuscular naltrexone in OUD; 
2. Formulate strategies for managing acute pain in the hospice setting, while minimizing risks for harm, misuse or diversion.  
3. Integrate multimodal analgesia into the overall treatment plan 
4. Formulate analgesic strategies based on the patient’s overall prognosis. 
5. Recognize how the interdisciplinary team can address psychosocial challenges frequently encountered in patients with OUD.