Purpose <p>Opioid prescribing at the end of life varies widely across clinical contexts, yet real-world evidence from Asian advanced cancer populations remains limited. This study characterized end-of-life opioid prescribing patterns and examined differences according to palliative care consultation status.</p> Methods <p>We conducted a retrospective cohort study using tertiary hospital clinical records linked to Korean National Health Insurance claims data. Patients with advanced cancer who received a palliative care consultation were matched 1:1 with those without consultation using propensity scores. Opioid prescribing during the last 30&#xa0;days of life was evaluated, including time-specific patterns across three intervals (30–15, 14–8, and 7–0&#xa0;days before death) and opioid strength (strong vs. weak).</p> Results <p>Among 18,048 eligible patients, 3,742 were matched in each group. Opioid prescriptions were more common among patients who received palliative care, with the largest differences observed 30–15&#xa0;days before death and narrowing toward the final week. Strong opioid use remained consistently higher in the palliative care group across all intervals, whereas weak opioid use showed minimal variation. Differences were most pronounced in older adults and in stomach, colorectal, and pancreatobiliary cancers.</p> Conclusion <p>Patients who received a palliative care consultation showed different patterns of end-of-life opioid prescribing, especially for strong opioids. Understanding such variation may support ongoing efforts to improve symptom management near the end of life.</p>