Researchers sought to report on racial/ethnic disparities in access to hospital-based opioid use disorder (OUD) services.

• Based on 2015–2018 community health needs assessments, a dataset marking the implementation of eight OUD strategies for a 20% random sample of nonprofit hospitals in the United States was constructed.

• Analyses revealed variation in hospital adoption of many OUD services based on the percentage of Black or Hispanic residents in their communities.

• Even after controlling for hospital size, the overdose burden in the community, community socioeconomic characteristics, and state funding, there were significantly lower odds of offering the most common hospital-based programs to address OUD – including programs that increase access to formal treatment services, prescriber guidelines, targeted risk education and harm reduction, and community coalitions to address opioid use – in hospitals in communities with high percentage of Black or Hispanic residents.