In the palliative care of patients with motor neurone disease (MND) symptoms are encountered that can be helped by the use of strong opioid medication. A retrospective survey of the 32 patients dying of MND at the Wisdom Hospice who required opioids showed that 75% received oral opioids, 94% received parenteral opioids and 72% received both oral and parenteral opioids. The median oral morphine dose was 60 mg/24 h, with a median duration of 51 days and the median parenteral dose was 180 mg/24 h with a median duration of use of three days. The results show that strong opioids can be used safely and effectively in the palliative care of patients with MND.