What Is Lean? The Harmful Substance and Its Side Effects

Though the silly name, sweet taste, and vibrant color of the drink “lean” may fool first time users into thinking that it isn’t so big of a deal and could never lead to a serious addiction problem, that couldn’t be further from the truth. The active ingredient in lean is an opioid, and so, like any other opioid drug that celebrities and un-knowing young people might be tempted to abuse, lean is pretty serious business.

Lean’s history dates back to the 1960s in Houston, Texas, when blues musicians began mixing cough syrup with alcohol and to abuse the resulting drug.The mixture evolved as the years went by, but today’s lean, also known as “purple drank,” has become increasingly popular—particularly in the hip-hop community. With artists such as Mac Miller admitting to being addicted to lean, the dangers of the concoction have become a huge focal point within the sprawling crisis of addiction.

Lean got its nickname because people who abuse lean can get to high that they have trouble standing up straight, meaning that they can only “lean” to one side. But lean is also known by several other names, including purple stuff, syrup, dirty sprite, texas tea, and sizzurp.

In recent pop culture history, artists and celebrities, including the rappers Lil’ Wayne, Bow Wow, and Soulja Boy, as well as the pop singer Justin Bieber, have each made headlines for their use of the substance, with many hip-hop songs featuring references to the drug. Dirty Sprite, one of lean’s other names, was even the album title of the rapper Future’s breakout mixtape.

What Does Lean Consist Of?

Lean is a concoction that contains two major active ingredients: promethazine (aka Phenergan, an antihistamine used to treat motion sickness or nausea) and codeine (a narcotic medication that is an opiate). Together, the two ingredients are used as a cough syrup, as it includes a pain reliever and a cough suppressant.

Drug enforcement administration classifies promethazine alone as a Schedule V drug. This indicates it has a low potential for abuse, though promethazine with codeine is listed as a Schedule III drug, making the potential for abuse somewhat more likely. Though if recent headlines are any indication, the potential for abuse of lean is an incredible danger.

Both promethazine and codeine are prescription medications, and are classified as central nervous system depressants. Because codeine is an opiate, its use is regarded as a last resort for those suffering from a severe cough, just as promethazine is specifically intended to treat allergies or motion sickness.

Lean is often a combination of the following:

• Promethazine with codeine
• Lemon-lime soft drink (such as Sprite)
• Hard candies (like Jolly Ranchers)

The ingredients are often mixed together and poured over ice in a large cup. With the hard candies mixed in, the substance is purple in color (hence the name purple drank) and is extremely sweet—making it palatable for the user to drink in large quantities. The amount of promethazine and codeine used when making the drink is typically 25 times that of the recommended dose.

Each of the ingredients in lean are legal, though Actavis, the pharmaceutical company that produced Prometh, a combination of promethazine and codeine, ceased production of the drug in 2014. One article featuring commentary from UT professor Ronald Peters referred to the extinct product as “the caviar of drugs.”

Although Actavis took their version off the market, lean as a whole continues to be abused. And a prescription isn’t always needed to make lean. There also exists a version of the lean drink that is made with an over the counter cough syrup that contains dextromethorphan, which is also known as DXM, as its primary ingredient.

The DXM cough syrup is then combined with alcohol and lean’s other ingredients. Though this version of lean isn’t as strong as the one that contains opioids, it does still have a potential for abuse and addiction, since it can produce a similar but less intense high.

Unlike prescription cough syrup, cough syrups that contain DXM do not require the approval of a medical professional to purchase, which makes them much more accessible than opioid based medications that must be prescribed by a doctor. However, abuse of DXM still comes with the risk of serious long term symptoms like liver damage, brain damage, and damage to the respiratory system, as well as with a risk of addiction.

What Happens When Drinking Lean?

Lean users may experience a feeling of euphoria that can be attributed to the opiate codeine. As the user drinks lean, they may also experience different side effects. Effects of lean include:

• Dizziness
• Blurred vision
• Nausea
• Memory impairment

Though the danger associated with opioids is relatively well-known, promethazine side effects are also risky, and can include:

• Seizures
• Severe drowsiness
• Confusion or hallucinations

An overdose of codeine can lead to coma or even death, which is why drinking lean in large quantities carries such an enormous risk. Respiratory depression can set in, as slow ineffective breathing can prevent the lungs from taking in all the oxygen that your body needs to function. If you notice that someone who is high on lean is showing this kind of slow, shallow breathing, you need to call for help immediately so that the person who has been misusing codeine can get the appropriate medical treatment. Long term use of opioids, including those found in cough medication that contains codeine syrup, is also linked to the risk of serious long term ill health effects.

How Do I Know If Someone Is On Lean?

You may be able to recognize that someone is on lean if they appear to be unusually drowsy, lethargic, or apathetic. They might also have a shorter attention span or less coordination than usual, and they may exhibit noticeably impaired judgement. You might also want to look into their eyes to check for dilated pupils.

The unusual amount of doctor’s visits that someone with a lean addiction needs to maintain a supply of prescription cough syrup to abuse regularly might also be a tip-off, as could less specific psychological symptoms related to addiction like a withdrawal from social life to focus on substances or a depressed, desperate mood.

Is Lean Addictive?

Following the death of Mac Miller, a known user of lean, rapper Bow Wow came forward to reveal his own addiction to the substance.

Bow Wow tweeted about his experiences using lean, writing in part, “Go back and watch the face off show BET gave us! Look how dumb i looked. My ranting i was angry every day. They try to protect the truth by saying i was dehydrated… nawww bro. I WAS HIGH OFF PROMETHAZINE CODEINE! Actavis. SAY NO TO THESE DRUGS.”

Experiences like those of Bow Wow and others prove that lean is a highly powerful drug, as well as highlight its highly addictive nature when it is used routinely.

Mac Miller’s passing has left the hip-hop community reeling. His death was eventually attributed to mixed drug toxicity involving fentanyl, a stronger opioid drug, as well as alcohol and other drugs. But his lean addiction could have been what set the stage for his abuse of other opioids like the one that caused his death.

If someone becomes addicted to opioids as they abuse lean, they may eventually resort to using stronger opioids out of desperation to avoid withdrawal symptoms if codeine is unable. They may also do so out of a desire for a stronger high or to offset tolerance to the desired effects of lean.

The fact that the lean drink contains an opioid cough medication as its primary ingredient also means that it can lead to unpleasant withdrawal symptoms, like insomnia, vomiting, body aches, fever, diarrhea and other flu-like symptoms.

These withdrawal symptoms can be unpleasant enough that they motivate someone with a lean addiction to continue to abuse the drug rather than suffer through the withdrawal process, in which case the help of professional treatment will most likely be necessary.

Addiction to codeine can lead to addiction to other opiates, and the use of lean should not be taken lightly. As use becomes more common, we must be aware of lean’s effects, and provide the proper treatment for those who are struggling with an addiction.

If you or someone you love is currently struggling with any sort of addiction, including an addiction to the drink lean, reaching out to a treatment program as soon as possible is the best way to help your loved one or yourself.

Reco Intensive offers comprehensive treatment programs that focus on your individual needs, allowing you to conquer your substance abuse and move from addiction into a full, long term recovery. To learn more about the kind of treatment programs we offer, call (561) 464-6533 today. Let’s get back to a brighter future.