Objectives <p>Cancer is a major public health issue and the second leading cause of death in the United States. Pain remains a serious sequela, with opioids commonly prescribed for pain management. This study examined racial and ethnic disparities in opioid prescriptions among adults with a history of cancer.</p> Methods <p>We analyzed pooled 2012–2021 Medical Expenditure Panel Survey (MEPS) data for adults (≥ 18 years) with a self-reported cancer history who had at least one opioid or non-opioid analgesic prescription. The primary independent variable was race/ethnicity (non-Hispanic White, Black, Other). Covariates included age, gender, marital status, education, insurance, and family income. Propensity score matching was applied to balance baseline characteristics. Survey-weighted logistic regression was used to develop adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Analyses were conducted in R (version 4.5.1), with α = 0.05.</p> Results <p>Among 5,151 unmatched participants, representing 5,847,397 United States adults with cancer who received analgesic prescriptions between 2012 and 2021, 3,840,706 received an opioid and 2,006,691 received a non-opioid. In the unweighted matched sample of 4,599, 62,6% were female, 82% were non-Hispanic White, 54.5% had private insurance, and 50.2% had GED or high school or equivalent. After matching, the weighted sample represents 5,215,808 adults overall, including 3,256,636 opioid users and 1,959,172 non-users. In adjusted analyses, only race and ethnicity were associated with opioid prescribing, with Black respondents having lower odds than non-Hispanic Whites (AOR 0.68, 95% CI 0.54 to 0.86, <i>p</i> &lt; 0.01), after adjusting for other covariates.</p> Conclusion <p>Racial and ethnic disparities persist in opioid prescriptions among United States adults with cancer, highlighting inequities in pain management.</p>