This chapter introduces the unique challenges faced by individuals with substance use disorders (SUD) as they approach the end of life and the teams who care for them. It explores the intersection of addiction and palliative care, highlighting the stigma, lack of access and complex medical needs that often accompany this population. These patients often experience complex physical, psychological and social needs due to the interplay of chronic substance use and serious illness. The chapter underscores the importance of a compassionate, holistic approach to end-of-life care that addresses both physical symptoms as well as the many psychosocial issues. Interdisciplinary teams caring for these patients must also navigate ethical dilemmas surrounding autonomy, consent and conflicts with caregivers, family and friends. This chapter also provides tips and techniques for health care teams to ensure they are taking care of their own mental and emotional health while doing this work. The goal of end-of-life and palliative care in this context is to provide holistic, person-centered care that acknowledges the complexities of SUD while ensuring comfort, respect and compression for the person in their final stages of life.