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The opioid overdose crisis underscores the need for health services among people who use drugs (PWUD) with concurrent pain. Investigating the effect of pain on barriers to accessing health services among PWUD. Prospective cohort study. A setting of universal access to no-cost medical care in Vancouver, Canada from June 2014 to May 2016. PWUD who completed at least one study interview. Data derived from interviewer-administered questionnaires were used for multivariable generalized linear mixed-effects multiple regression (GLMM) analyse