Background: Pain management in cancer patients is a crucial aspect of their overall care, aiming to alleviate suffering and enhance their quality of life. However, the involvement of multiple care providers during cancer treatment can lead to complex and varied approaches to pain medication prescribing. This abstract provides a review of pain medication (PM) prescribing patterns for cancer patients. Methods: Using prescription, drug administration, and episode data from 2016 to 2022 for 15 physician group practices in The US Oncology Network participating in the Oncology Care Model (OCM), we evaluated the narcotic PM prescribing patterns. Results: Of 304,951 episodes for 127,296 unique cancer patients, 38.6% of episodes and 55% of patients had PM prescribed. 35.3% of PM were prescribed by oncology providers, 7.5% by pain management providers. 30.7% of episodes had PM prescribed by an oncology provider only, and 4.8% by a pain management provider only. 41.5% of episodes had PM prescribed by more than 1 provider, and 41.5% episodes had more than 1 PM prescribed. Some prescription patterns are provided (Table). 7 drugs accounted for about 87.5% of the PM prescriptions. However, individual drug choices were considerably different among providers. Conclusions: Overall, this review sheds light on the complex landscape of PM prescribing patterns for cancer patients. Oncology providers, by virtue of providing the preponderance of care for cancer patients, also prescribe PM to their patients. Concurrent PM prescribing by multiple providers for cancer patients opens the door for unintended adversities. Despite the complexity of managing cancer related pain, pain management specialists are seldom engaged in managing cancer pain. Different prescribing providers make distinct drug choices and follow different prescription patterns. Evaluating guideline concordance and the knowledge of appropriate pain management strategies among oncology providers is an area for further exploration.