“A scientist's aim in a discussion with his colleagues is not to persuade, but to clarify” [1]. We therefore thank D.C. Currow and co-workers for both their comments and the opportunity to continue the discussion regarding the risks and benefits of using opioids to treat refractory chronic breathlessness. The purpose of our recent case report [2] is not to persuade clinicians to prescribe or not prescribe opioids for the off-licence indication of refractory breathlessness, but to highlight and clarify risks of prescribing opioids in this clinical setting and when practising real life medicine, which is so different from the carefully controlled and managed environment of clinical trials.