Opioids are the most powerful drugs commercialised for acute and chronic pain relief. The main emerging problem in our midst is the abuse and addiction to synthetic opioids iatrogenically established in general population.

We report the case of a female patient aged 48 admitted to the Acute Psychiatric Unit after a suicide attempt. She refers she finds herself more irritable and depressed since she began a treatment with oxycodone after she was diagnosed with fibromyalgia. She has lost a lot of weight, is not able to get to sleep and has become socially isolated.

During the first few days, the patient is uncooperative and shows a marked self-referentiality and verbalises delusional ideation related to her immediate surroundings. Once the treatment with opioids was withdrawn and we had prescribed paliperidone ER, she seemed more cooperative and calmed. She was discharged from the Psychiatric Day Hospital showing a good evolution.

Paranoid personality disorder (F60); mental and behavioural disorders due to use of opioids (F11); recurrent depressive disorder, current episode moderate (F33.1); fibromyalgia (M79.7).

The use of synthetic opioids (tramadol, fentanyl, oxycodone) in easy-to-use formats (patches, pills, dispersible tablets, lollipops) and their dissemination in pain treatment, is leading to an increase of problems related to it, both their side effects (psychotic symptoms) and the generation of misuse and addiction. We should pay greater attention to the prescription of opioids to patients with dysfunctional personality traits.

The authors have not supplied their declaration of competing interest.