Background: Pancreatic cancer is associated with significant symptom burden, a poor prognosis, and a poor quality of life. Early involvement of palliative care alongside standard disease modifying treatment in metastatic pancreatic cancer has been associated with improved quality of life and improved symptom burden. Receipt of opioids has been shown to improve overall survival in patients with pancreatic cancer, while escalating opioid usage has been associated with higher risk of death. Given this dichotomy in prognosis, the utilization of a long-acting opioid for cancer-related pain should warrant a palliative care consultation. Methods: This is a retrospective study conducted under an IRB-approved protocol of patients who were diagnosed with pancreatic cancer between January 1, 2021 and May 30, 2023, and who had been prescribed a long-acting opioid for cancer-related pain at our institution. Data collection including patient demographics, opioid doses, hospice utilization, date of death, and aggressive interventions at end-of-life were collected via chart review. Descriptive statistics were calculated using means and medians. Statistical methods included percentage calculations of baseline characteristics. Time from initiation of long-acting opioid to death was measured. Results: Of 51 patients surveyed, 50 met eligibility criteria for our study. The median age was 66 years (Range 42-90). Stage at diagnosis included 6 resectable, 6 borderline resectable, 12 locally advanced, and 26 metastatic. Ten were able to undergo a surgical resection. 28% of patients died within 90 days of starting a long-acting opioid. 36% died within 180 days of starting a long-acting opioid. Access to palliative care services was associated with increased utilization of medical cannabis (P=0.00001) and documentation of MOLST (Medical Orders for Life Sustaining Treatment) forms (p=0.049). Access to palliative care consultation (p=0.0007) as well as access to medical cannabis (p=0.00001) was more likely at academic main site as opposed to satellite hospitals. Conclusions: The initiation of long-acting opioids in patients with advanced pancreatic cancer should be considered as a trigger for palliative care involvement as it portends a poorer prognosis. Furthermore, even at a single institution, there were disparities in access to specialty palliative care resources. Further research needs to be conducted to optimize timing of palliative care referrals in a resource limited environment.