<p>Young people across the world use opioids and experience drug-related harms yet remain excluded from many opioid-related harm reduction policies and services. In this commentary, we trace our collective advocacy as young people who use opioids and youth harm reduction workers from Canada, Indonesia, Kenya, Mexico, Uganda, and the United States. Specifically, we describe the creation of our Youth RISE cohort in 2023 and our community engagement to strengthen access to harm reduction for young people globally. Over a two-month period, we held weekly online meetings where we exchanged perspectives and experiences with three set thematic discussion topics—needs, challenges, and recommendations—related to youth opioid use and harm reduction within our respective countries. Our work reflects the challenges we have faced confronting entrenched prohibitionist policies and navigating services that stigmatize and control young people who use opioids. Despite these challenges, we share a commitment to advance person-centered harm reduction and push for structural reforms to improve the health and rights of young people who use opioids and other drugs. Recommendations from our work together converge on the need to move beyond punitive approaches toward comprehensive, youth-tailored harm reduction grounded in evidence, equity, and human rights. Specifically, we call for investment in youth-tailored harm reduction programs (e.g., drug-checking, supervised consumption spaces, naloxone), prescribed alternatives, comprehensive drug education, and systemic action to address the stigma and surveillance that come with abstinence-focused approaches to youth opioid use. Beyond this, we argue that meaningful youth engagement is essential to genuinely resourcing youth harm reduction and ensuring that it effectively responds to young people’s diverse and evolving realities of opioid use amid the harms of criminalization and prohibitionist-based drug policies.</p>