Lean is a drug “cocktail” made of prescription cough medicine, hard candy and a soft drink, usually Sprite. People also call it “purple lean,” “purple drank,” and “sizzurp.” The prescription cough medications in lean contain codeine, an opiate used as a cough suppressant. Codeine can also produce pain relief and sedative effects. The antihistamine promethazine is another ingredient usually present. Promethazine can contribute to sedation and impairment of motor skills. The effects of codeine and promethazine are made more dangerous by certain prescription medications. A person who is taking anti-anxiety medications or other central nervous system depressants, even as prescribed, is at greater risk. 

When codeine is consumed in excessive amounts, it can lead to extremely harmful effects. Because the drug is consumed in a drink it’s easy to lose track of how much you’ve taken. This risk is amplified by the cough syrup’s flavor being masked by soda and candy. This is where much of the danger lies. The syrup used  has at least two active ingredients by itself. It is often combined with still more drugs increasing the risk of unexpected adverse side effects. Because the mixture is easier to consume than hard alcohol might be alone, it’s easy to lose track of. Lean is often combined with other intoxicants. The combination of opiates and central nervous system depressants with alcohol and other substances exponentially increases the risk of danger.  

Side Effects of Lean

Side effects will gradually become more severe the more you drink. First-time users may also encounter unpleasant side effects, including dizziness, blurred vision, nausea, and impaired memory. Repeated, long-term use can also result in extensive health problems. Chronic use has been shown to cause organ problems including pancreatitis and liver damage. Other negative health consequences include birth defects (when consumed by pregnant women), infertility and hormonal problems. The excessive amount of sugar in the mixture can also be dangerous to anyone who is diabetic or pre-diabetic. 

People who drink lean on a frequent basis report developing tooth decay. Unwanted weight gain, constipation, and urinary tract infections are also common complaints. People who use lean regularly  and in large amounts run the risk of a deadly overdose. This danger is much greater when the drug is used in combination with other depressants, such as alcohol. The amount and exact composition of active ingredients can vary in different formulations of cough syrup. This makes it even more difficult to accurately control the amount of various drugs a person is ingesting. This danger is compounded by the inherently compromised judgement in a “party” atmosphere. Consider the fact that the person preparing the mixture is often under the influence themselves. 


Codeine is an opiate and is also one of the psychoactive ingredients in lean that is behind both its desirable dangerous effects. Opiates and opioids are in a class of drugs associated with an extremely high rate of abuse, dependence, and addiction. The remarkably addictive nature of opioid drugs is due, in part, to the pleasurable and rewarding effects that they produce, including euphoria and relief from anxiety and stress.

Because codeine is legal when prescribed by a doctor and used legitimately by many people to manage cough or pain, it’s somewhat difficult to track rates of abuse and addiction. Long-term opioid abuse can lead to the development of drug tolerance and dependence. As tolerance grows, people often find themselves needing to use more and more of the drug to feel the coveted effects.

This increase in drug-taking behavior can be a catalyst for the development of physiological dependence. Opioid-dependent people will experience unpleasant withdrawal symptoms if they try to discontinue drug use. In the early stages of withdrawal, the person may experience the following:

  • Sleep disturbances
  • Agitation
  • Anxiety
  • Depression
  • Muscle aches and pains
  • Teary eyes
  • Runny nose
  • Excessive sweating

If a person has used lean for an extended period or in very high doses, they may encounter more intense withdrawal effects, including nausea, vomiting, stomach cramps, and diarrhea. To avoid or postpone withdrawal symptoms, people dependent upon it will frequently relapse, or return to consuming the drink or other opioid drugs. This behavior only serves to perpetuate an endless cycle of abuse that can ravage their mental and physical health.

Lean in the Media

Lean in the Media

The drug combination known as lean or purple drank has been promoted as a desirable high by several high-profile celebrities, most notably musicians such as Lil Wayne and Justin Bieber.

Although it;s “cool” media presence may encourage some young people to use, the reality is, even those who have been credited with making the mixture famous have suffered from health complications. For example, Lil Wayne reportedly began experiencing seizures several years ago after a long history of  abuse.

There have also been a few celebrity deaths associated with lean. In November 2000, DJ Screw, who popularized the consumption of the drink, died of an overdose related to codeine, promethazine, and alcohol. Then in October 2007, Big Moe, a protégé of DJ Screw who frequently rapped about use of the drug died at age 33, after suffering a heart attack. It was believed that lean might have played a key role in his death.

Treatment for Codeine Addiction

Because the withdrawal symptoms that result from codeine addiction can be highly unpleasant, many patients opt for medical detox and then immediately transfer to an intensive addiction treatment program. Harmony Recovery Center offers comprehensive programs in partial-hospitalization and outpatient formats. These programs include evidence-based approaches to substance abuse treatment, such as psychotherapy, individual and family counseling, and peer support.

During treatment, compassionate, highly-skilled addiction professionals care for patients and provide them with the resources and support they need to navigate sober life after treatment has been completed.

We are dedicated to helping our clients reclaim their lives, free from addiction to drugs and alcohol. Please call us as soon as possible to find out how!

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