This paper provides evidence on the effect of local prescription opioid use on academic achievement of 3rd-8th graders between 2009 and 2018. Using county fixed effects models, I find that when counties have higher levels of prescription opioid use, students score lower on standardized assessments two to three years later, with variation by student subgroups and magnitudes comparable to effective interventions. I find the largest magnitudes in counties with higher poverty rates and states with below-median state education spending. As test score effects predict adult outcomes, these findings point to economic and public health challenges when affected children become adults.