Copper is a trace element with higher concentrations in the brain, liver, and kidneys. Its toxicity is rare in humans because of its homeostatic mechanisms. This case highlights a 30-year-old male with a history of opioid abuse and occupational exposure to metallurgy. Despite treatment, a gradual neurological worsening prompted us for heavy metal screening and nerve conduction velocity study (NCV) which revealed copper toxicity and demyelinating polyneuropathy. Following the initiation of D-penicillamine therapy, he showed gradual improvement. The coexistence of opioid abuse and dependency posed challenges in the clinical presentation, necessitating a comprehensive approach to effectively manage both opioid withdrawal and evaluation for other toxic substances
