To evaluate national trends and specialty-specific variation in pain management and addiction education across ACGME-accredited residency and fellowship programs from 2020–2024.

We abstracted program-level data from ACGME Data Resource Book tables for academic years 2020–2021 through 2023–2024, encompassing 31 core specialties plus the total training pipeline. Outcomes were proportions of programs teaching non-pharmacologic pain management, pharmacologic pain management, opioid prescribing, and recognition, referral, and treatment of SUD. Communication and stigma-reduction training were analyzed where available (2022–2023 onward). Linear regression models assessed temporal trends; Cochran-Armitage tests confirmed monotonic increases. Statistical significance was set at p<0.05.

All six core domains demonstrated statistically significant growth (p≤0.027). Non-pharmacologic pain management rose from 81% to 89% (p=0.007), pharmacologic management from 88% to 93% (p=0.003), opioid prescribing from 88% to 92% (p=0.027), and recognition of SUD from 87% to 94% (p=0.008). The steepest improvements occurred in referral (76%→86%, p=0.002) and treatment (51%→65%, β=+4.67 percentage-points/year, p=0.001) education. Communication (39%→61%) and stigma-reduction training (35%→56%), introduced in 2022–2023, expanded dramatically in one year (both p<0.001; Cohen's h≥0.43). By 2023–2024, Anesthesiology, Family Medicine, Emergency Medicine, and Internal Medicine achieved ≥97% coverage, while Medical Genetics (62%) and Dermatology (80%) remained significantly below the pipeline mean (p<0.001).