Velocardiofacial syndrome is a genetic disorder associated with a microdeletion on the long arm of chromosome 22, and this segment is responsible for coding catechol-O-methyltransferase, an enzyme involved in dopamine degradation. We submit a case of velocardiofacial syndrome and Madelung deformity of the wrists presenting with hallucinatory phenomena associated with opioid exposure. Overactivity of the dopaminergic system has been postulated to cause schizophrenia in this population, and here we speculate that dysregulation of dopamine metabolism may have predisposed our patient to an increased risk of opioid-induced hallucinations. Further research is necessary to explore this relationship.