Differences in Diagnosis and Treatment Across Racial-Ethnic Groups with Co-Occurring Chronic Pain and Opioid Use Disorder: A Scoping Review

Objective To map literature on racial-ethnic differences in the management of individuals with co-occurring chronic non-cancer pain (CNCP) and opioid use disorder (OUD), and to scope clinician, system, and patient factors that may contribute to these differences. Methods Scoping review of five databases through 05/01/2025, following PRISMA-ScR guidelines. CNCP was defined as pain lasting ≥3 months unrelated to malignancy; OUD was identified through diagnostic codes, clinician assessments, or validated proxies. Eligible studies included adults with both conditions and reported outcomes stratified by participant race or ethnicity. Data were extracted and appraised using the Mixed Methods Appraisal Tool. Findings were synthesized inductively across four themes: Prevalence and predictors, treatment differences, provider decision-making, and patient-reported experiences. Results 21 studies were included, encompassing prospective, retrospective, cross-sectional, and qualitative designs. Among patients with CNCP and OUD, Black and Hispanic groups were less likely to receive non-pharmacologic pain treatments, pain specialist referrals, or buprenorphine for OUD. Conversely, opioid prescribing rates and OUD diagnoses were higher among White patients. Patients reported experiences of differential treatment and stigma, a finding reinforced by clinician interviews that described greater reluctance to prescribe opioids to non-White racial and ethnic groups. None of the reviewed studies found that non-White individuals faced a higher risk of opioid misuse or OUD; instead, key predictors included pain-related distress and treatment access barriers. Conclusions Differences in CNCP and OUD care may relate to access-related factors and stigma. Comprehensive research and improvements in treatment access are necessary to ensure accessible and integrated care.