Topical morphine has been used on open wounds for pain management, but has a variable duration of action not suitable for palliative dressing changes. The objective of this study is to find an opioid and delivery method that would provide long-lasting pain relief between dressing changes. Methadone powder (100 mg) was mixed in Stomahesive powder (10 g) and sprinkled on the open wound once daily at the time of dressing change. Four cases are presented with varying results using the methadone/Stomahesive mixture. Exudative wounds with exposed tissue work best, whereas dry wounds with eschar show less response. Topical methadone powder can be effective for pain relief in open, exudative wounds with little eschar. Further research questions are raised.