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investigated. © 2020 The Authors. European Journal of Pain published by John Wiley Sons Ltd on behalf of European Pain Federation - EFIC®.AIM To identify associations between opioid-related mortality and neighborhood-level risk factors. DESIGN Cross-sectional study. SETTING Massachusetts, USA. PARTICIPANTS Using 2011-2014 Massachusetts death certificate data, we identified opioid-related (n=3,089) and non-opioid-related premature deaths (n=8,729). MEASUREMENTS The independent variables consisted of four sets of neighborhood-level factors (1) p