Individuals with current or past substance use disorder (People who use drugs – PWUD) can have particularly complex needs when faced with a palliative diagnosis. They often have difficult social circumstances including high levels of deprivation, inadequate housing and limited social support. Mental ill-health and a history of trauma or abuse is common. For a variety of reasons, health care services can struggle to engage PWUD. Late presentation of advanced disease is common, pharmacology of symptom control can be complex, and continuity of care difficult. With a high level of substance use in Scotland and an ageing cohort of PWUD, palliative care for this population is of growing importance. It is essential to offer empathetic, joined-up, non-judgemental care.