Purpose <p>Hispanic/Latina breast cancer patients receive fewer opioid prescriptions for cancer-related pain. The primary aim of this study was to explore opioid prescription rates among Hispanic/Latina breast cancer survivors living in Puerto Rico.</p> Methods <p>This cross-sectional study analyzed opioid prescription use in a retrospective cohort of Puerto Rican breast cancer women using the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database. Adjusted odds ratios and incidence rate ratios with 95% confidence intervals were estimated using logistic and negative binomial regression analyses to assess factors associated with the use and frequency of opioids use.</p> Results <p>Puerto Rican breast cancer survivors, mostly 40–64&#xa0;years old were included (<i>n</i> = 1,733). Opioid prescription three years following their breast cancer diagnosis was 13.1%. Participants enrolled in Medicare (AOR = 9.77) and dually eligible for Medicare-Medicaid (AOR = 5.54), with a comorbidity index of 1 (AOR = 1.50), with a history of opioid use before their cancer diagnosis (AOR = 2.49), and that received chemotherapy (AOR = 1.47) were more likely to be prescribed opioids. Analyses in rates of opioid prescription revealed statistically significant increases among those enrolled in Medicare (IRR = 17.51) and dually eligible for Medicare-Medicaid (IRR = 11.74) and for those with a history of opioid prescription before diagnosis (IRR = 4.16).</p> Conclusion <p>Future research should explore how factors such as structural racism and geographic isolation shape opioid prescription and usage among breast cancer survivors living in Puerto Rico.</p>