hort compared with outpatients in the study by Edelman et al 1 may have masked a comparably smaller effect of opioids.A strength of our study is the higher homogeneity of patients regarding the indication of opioid treatment (cancer pain). Despite the great efforts of Edelman et al 1 to control confounders, opioid use in veterans with and without HIV infection is a powerful surrogate for a large range of detrimental health conditions (opioid use for musculoskeletal and bone diseases with decreased mobility 4 or chronic cough [dihydrocodeine]). 5 Further observation, ideally in a controlled prospective trial, is warranted before adapting current standards in cancer care.