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1. Identify candidates for topical morphine use in pain refractory to other analgesics and opioids. 2. Describe evidence behind use of morphine gel in palliative care and barriers to use in a practical setting. Opioids are a mainstay of treatment for moderate to severe cancer-related pain. Conventional opioids act on opioid receptors in the central nervous system; however, opioid receptors are also present in the skin, providing an opportunity for their use as a topical analgesic when there is skin breakdown and potentially limiting systemic side effects. Topical morphine has demonstrated effective pain relief in palliative care patients, but its use is uncommon and evidence is limited. As a result, it is not widely available or affordable. Ms. B is a 76-year-old female with a history of recurrent lung adenocarcinoma for which she underwent radiotherapy targeting a left lower lobe mass. After radiation she began to develop skin erosions on her back that caused significant pain and greatly reduced her functionality and independence. She was referred to the outpatient palliative care clinic after seeing multiple other specialists. She had previous trials of acetaminophen, gabapentin (oral and topical), lidocaine (patch and ointment), oxycodone, and intralesional anesthetics, which were all ineffective or resulted in intolerable adverse effects. Due to the size and nature of her lesions, she was a candidate for trial of topical morphine gel. Many logistical barriers were encountered, including availability and cost to the patient from a compounding pharmacy. She reported significant relief at her next visit with palliative care but expressed anxiety regarding whether she would be able to continue to afford it. Studies show topical morphine effectively provides local analgesia in palliative care patients without producing systemic effects, but sample sizes are limited and its use is still rare. This presentation will discuss topical morphine's place in therapy and appropriate patients for its use, as well as highlight the primary barriers to its use including out-of-pocket cost to patients from lack of coverage by most prescription insurance plans. [ABSTRACT FROM AUTHOR]