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In response to the growing opioid epidemic, this multiple case study investigation explored schools in crisis regions. Select elementary schools in Massachusetts, Maine, and New Hampshire partook in the study. There were 76 participants ranging from district administrators, teachers, counselors, to mental health providers. Children environmentally exposed or born addicted to opioids may have cognitive, social-emotional, and behavioral impairments. Additionally, students in kindergarten through second-grade are experiencing adverse childhood experiences in their environments and community because of opioid exposure. Consequently, these exposures are impacting the schools. Evidence collected from this study suggests that there is a lack of organizational systems and proactive plans to support the schools, educators, and students impacted by the epidemic.