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Issues: The opioid crisis in North America has increased concerns about adolescent problematic opioid use. Schools are crucial in prevention efforts, but the effectiveness of school-based educational programs is debated. This review evaluates the effectiveness of school-based opioid education programs in preventing opioid-related harms, and improving knowledge, attitudes, and beliefs about opioids among youth., Approach: Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, ERIC, and Web of Science databases were searched in January 2025. Included studies met the following criteria: (1) were published in English; (2) conducted in a middle or high school setting; (3) the intervention related to opioid education; (4) randomized trials or observational studies; and (5) published between January 2000 and January 2025., Key Findings: Among 1405 studies screened, eight met the inclusion criteria and evaluated seven school-based opioid education programs with participants aged between 11 and 18 years. Most studies used quasi-experimental designs, and only one was a randomized controlled trial. One study showed that combining classroom-based interventions in grade 7 with sessions that involved parents participating alongside students significantly reduced prescription opioid misuse, with effects lasting until grade 12. Four studies showed improved knowledge and attitudes towards opioid use and two showed increased understanding of opioid withdrawal and overdose management., Implications and Conclusion: This review is the first to evaluate school-based opioid education programs for adolescents. Findings indicate that these programs effectively increase opioid knowledge and reduce problematic opioid use, though further randomized trials among diverse participant samples are needed to confirm efficacy and generalizability of findings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)