Pain is common in those with a life-threatening illness, yet barriers to adequate treatment persist. New challenges add to the well-known barriers of limited education, lack of time, and impaired access to expert treatment. The opioid abuse epidemic and the rising rate of deaths related to misuse of opioids present new obstacles to cancer pain relief. Although many of the efforts to reduce the impact of the opioid epidemic are important to the community, there are unintended consequences. When facing these challenges, ethical principles serve as a guide to the provision of safe and effective pain control in hospice and palliative care. The ethical principle most challenged during our current state is justice, the equal and fair distribution of resources. There are numerous examples of unfair distribution of cancer pain treatment, notably limited access to pharmacologic and nonpharmacologic therapies. Hospice and palliative nurses who are dedicated to the provision of excellent cancer pain care can ensure equitable distribution of resources, including opioids. Solutions to the challenge of fair access include individual professional development, interventions by health care organizations, and action by professional organizations.