In the late 1990s, popular music highlighted the misuse of prescription strength cough medication containing codeine and promethazine by mixing it with Sprite and candy or alcohol, calling it lean, syrup, sizzurp, or purple drank.
Codeine is an opioid drug, and promethazine is an antihistamine with sedative properties.
Use of lean has a high risk of a potentially fatal overdose, especially when it is combined with alcohol or other drugs. Opioid drugs like the codeine contained in lean are also highly addictive.
Treatment for opioid use disorder involves a broad approach, usually with therapies and medications.
What Is Lean?
Lean has had many street names over the past few decades. It generally refers to the combination of a prescription cough medication that contains either (or both) the opioid codeine and the antihistamine promethazine mixed with soda (typically Sprite) and hard candy and/or alcohol.
Codeine is an opioid drug that blocks pain sensations, causes euphoria, and slows down functions of the central nervous system, including heart rate, respiration, blood pressure, and body temperature.
Promethazine is an antihistamine that can decrease allergy symptoms. It is also a sedative that causes drowsiness.
Both codeine and promethazine can slow down bodily functions, making these medications highly dangerous to misuse.
How Did It Become Popular?
Popular music and rap superstars highlighted purple drank, or sizzurp, in the late 1990s, showcasing it in their music and music videos.
Opioid drugs, including lean, are common in the hip hop music scene, and their risks are often downplayed. Lean is also popular at electronic dance music (EDM) parties with nearly 16% of attendees surveyed in New York City in 2018 reporting ever using it.
Lean is often praised on social media. A study shows that about half of the images on Instagram depicting codeine misuse show it combined with soda as lean.
Lean is popular with youth, and it is commonly mixed with alcohol.
Purple Drank Side Effects
Lean often contains both codeine and promethazine, although it can contain only one or the other. Side effects of an opioid drug like codeine include the following:
- Slowed heart rate and lower blood pressure
- Decreased body temperature
- Dry mouth
- Mental impairment
- Lack of coordination and balance
- Impaired vision
- Memory loss
- Mood swings
Sedation is a side effect of promethazine. When the two medications are combined in a prescription cough medicine, the rate of drowsiness and the potential for loss of consciousness increase.
Lean has a high risk for a potentially life-threatening overdose. It is also habit-forming with regular use, often leading to physical dependence and then addiction, or substance use disorder (SUD).
Is Lean Addictive?
Lean contains codeine, which is a highly addictive opioid drug.
Opioid drugs bind to opioid receptors in the brain. This blocks pain sensations and changes the chemical makeup and reward pathways of the brain. People also experience pleasure and a dampening of negative emotions.
With frequent use, tolerance can develop, which means they need more of the drug to achieve the same effects. It can then be difficult to feel happy or “even” without the drug in their system.
This can cause a person to feel the need to take more of the drug to balance things out. When the drug wears off at this point, difficult withdrawal symptoms can occur. This further encourages the person to take the drug again.
Repeated use of lean actually changes the way your brain perceives pleasure. This can quickly lead to compulsive use and eventually SUD.
Withdrawal From Lean
Regular use of lean can cause physical dependence. This means that when the drug processes out of the body, withdrawal symptoms can kick in. These can include the following:
- Nausea and vomiting
- Muscle aches
- Joint and back pain
- Sleep difficulties
- Excessive sweating and chills
- Irregular blood pressure and heart rate
Overdose: Can Lean Kill You?
An overdose on lean can be fatal. Codeine slows down life-sustaining functions, such as heart rate and breathing. High doses can stop your heart and lungs from working as they should.
Signs of an overdose include the following:
- Small or pinprick pupils
- Nausea and vomiting
- Cold and clammy skin that almost looks blue
- Extreme drowsiness or loss of consciousness
- Mental confusion and agitation
- Dizziness and loss of balance and coordination
- Drop in heart rate and blood pressure
An overdose is a life-threatening emergency, requiring immediate medical attention.
Dangers of Mixing Lean With Alcohol & Other Drugs
Lean is commonly mixed with alcohol and other drugs, which increases all of the potential side effects. It also raises the risk for a potentially fatal overdose, is addictive and can cause SUD, and compounds the possible rate of complications.
Alcohol and benzodiazepine drugs, or sedatives, are central nervous system depressant substances. When mixed with the codeine in lean, which is also suppressing those same life-sustaining functions, the odds for an overdose increase.
Lean mixed with alcohol and other drugs can be fatal.
In 2020, nearly 3 million Americans ages 12 and older misused a codeine product, and this includes lean. Over 2.5 million people in the United States had an opioid use disorder (OUD).
Opioid addiction is common. Using lean increases the odds of opioid use disorder (OUD).
Treatment for Purple Drank Addiction
OUD is treatable, often with a combination of medications and therapeutic techniques. Medications used in MAT (Medications for Addiction Treatment) can help to balance out withdrawal symptoms and decrease cravings, helping to achieve and maintain recovery.
Therapies, such as cognitive behavioral therapy (CBT), help to teach mindfulness and the ability to identify negative and potentially destructive thought patterns that can lead to unhealthy behaviors. Healthy habits and coping skills can decrease drug-seeking and high-risk actions.
There are different levels of treatment based on individual needs and circumstances.
Inpatient, or residential, treatment programs offer around-the-clock care, support, and supervision. Outpatient programs can provide more flexibility when individuals need to attend to family, work, or school obligations.
Is promethazine a narcotic?
No, promethazine is an antihistamine drug and not a narcotic. Codeine, the other ingredient in lean, is a narcotic.
Is codeine an opioid?
Yes, codeine is an opioid drug.
Can drinking lean kill me?
Lean use, especially when mixed with alcohol, can cause a fatal overdose.
Is it safer to use prescription drugs than “hard” ones?
Misuse of any drug, even one prescribed by a doctor, is dangerous. In the case of lean or purple drank, use includes the risk for potentially life-threatening side effects.
Can I get addicted to lean?
Yes, lean contains codeine, which is a highly addictive substance, so yes.
Are there treatments for lean addiction?
There are a variety of effective treatments for lean addiction. Opioid use disorder treatment often includes medications and therapy.