Patients with renal or hepatic disease often experience pain, particularly with serious or advanced illness, requiring opioid therapy. We are fortunate to have an array of opioids to select from when treating these patients, however all opioids are not created equally. Some opioids are preferred, or should be avoided in renal impairment, hepatic impairment, or both. Participants in this session will learn which opioids are preferred in renal impairment, dialysis, and hepatic impairment, and which are discouraged. The rationale for these decision will be addressed, and applied to simulated cases.