Potentially inappropriate opioid prescribing increases risk of patient harm and misuse. This study used videos and written vignettes to explore how patient race and previous opioid misuse behaviors impact providers’ risk assessment for future prescription opioid-related problems. Findings indicate that black patients were perceived by both residents and fellows to be at greater risk for future adverse events and diversion regardless of previous misuse history, suggesting that racial minorities with chronic pain may be vulnerable to unintended consequences of public health efforts to reduce opioid prescribing.