Dxm, Codeine And More

I have a patient who takes psychotherapy from me and suffers from various slight psychological and neurological symptoms. He OD'ed some time ago with a mix of substances; his slightly reworded history is below.
Warning: patient's recall of events discussed is pretty inexact, and he thinks that his short memory was impaired in some way at that time.
All throughout - countless cigarettes; anamnesis includes heavy alcohol and nootropics abuse
+0:00 200mg DXM HBr, 100mg codeine phosphate
+20:00 100mg DXM HBr
+30:00 unindentified "legal LSD" powder

It all started with a typical "why not have some DXM" weekend.
All went as usual, except that previous lack of sleep made him feel slightly dumb and unconcentrated. He extracted 200mg of DXM, and went for a walk. Next morning he decided to add one more (pure) syrup and, some time later, remains of some street-bought psychedelic powder that he used before (it feeled slightly stimulating and slightly toxic, but "nice overall").
Some 5-10 minutes after drinking powder solution he started to feel *really intense* periodic burning all down the throat and esophagus, probably due to unexpected drug interaction effects and/or acid reflux. It was so unexpected and painful that he thought that he accidentally took some alkaliÑ extraction waste products (which never were at the table, at least not in any of cups or glasses; but now he's not really sure) and drank some lemon acid solution, which seemed to make it even worse. Drinking milk and water eased it but not much, and not for long.
Long story short, after 2-3 hours in course of which his thoughts ranged between "I already have no esophagus, so I'll die soon" and "WTF is happening, I need to smoke and think a bit", he started to feel more or less OK.

Morals: when mixing DXM with any other drugs, take extreme caution.
Question: what could it possibly be? The unknown substance and the effect it caused

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Hello,

Based on my research, Dextromethorphan interacts with 56 different medications- possibly more. 28 of those reactions are major, 23 are moderate, and 5 are minor. It's impossible to know what your patient's reaction worse since there are so many drugs that Dextromethorphan can interact with... Why exactly was your patient taking all these medications? I imagine he wasn't under your care when he did all of this? I'm just trying to understand the situation..

You can learn more about this drug on the page for Dextromethorphan Details

Please post back if you have any more information to add, or if you have any questions!

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