Cough Syrup with Codeine Abuse, Also Known as Lean and Purple Drank

3 min read · 7 sections
Evidence-Based Care
Expert Staff

Codeine is a prescription opioid drug that treats mild pain and acts as a cough suppressant.
However, because of high rates of abuse, the Drug Enforcement Administration has moved the substance into Schedule III, so it is more closely monitored and controlled when it is placed in cough syrups – its primary application in the US.

Cough syrups have been widely abused for years, especially by adolescents who want to get high or drunk without stealing alcohol or paying for illicit drugs. Since cough syrups are legal for purchase, many people have abused these medicines; however, since the alcohol has been removed and codeine-based cough syrups restricted, abuse patterns in the US have changed.

One of the ways that people abuse codeine cough syrups is by mixing them into alcoholic beverages or nonalcoholic sodas, creating a dangerously intoxicating mix with several nicknames. The most famous names are “lean,” “purple drank,” “syrup,” and “sizzurp.” These mixed drinks have been popularized by rappers and pop stars.

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What Are Purple Drank, Sizzurp, Syrup, and Lean?

codeineCodeine cough syrup’s main ingredient is a mild opioid narcotic, making it a target of abuse for people seeking narcotic highs. Many codeine cough syrups no longer contain alcohol, so purple drank and similar brews often contain alcohol. Some of the cough syrups may also contain dextromethorphan, or DXM, a cough suppressant that replaced codeine in over-the-counter cold and flu medicines. This drug is also intoxicating and dangerous, and has become a target of abuse. Another sedating drug often found in cough syrups is promethazine.

The mixture of cough syrup, alcohol, soda, and sometimes hard candy like Jolly Ranchers first became popularized in the 1990s. Since then, the DEA has rescheduled codeine so it requires a prescription, and both federal and state authorities track these prescriptions, along with the sale of cough syrups in general. These laws were instituted due to meth production in small labs in the US, which used cough and cold medicines.

Purple drank derives its name from the classic purple color of most codeine cough syrups;

How Common Is This Problem?

In 2014, the DEA believed that one in 10 teens abused codeine cough syrups in this way to get high. The Substance Abuse and Mental Health Services Administration (SAMSHA) reported in 2008 that 3 million adolescents and young adults, usually between the ages of 12 and 25, had used cough or cold medicines to get high; this number included those using codeine-based cough syrup and over-the-counter DXM drugs.

This kind of substance abuse is also part of hip hop culture, with numerous celebrities ending up hospitalized or dead due to the mixture, or due to mixing sizzurp with other intoxicants like marijuana.

What Are the Effects and Dangers of Cough Syrup Abuse?

With codeine, alcohol, and potentially other central nervous system depressants involved, sizzurp can be very dangerous and produce serious side effects. Some effects include:

  • Euphoria
  • Sedation
  • Memory loss
  • Loss of coordination
  • Withdrawal symptoms
  • Dissociation
  • Seizures
  • Cravings and addiction

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Can You Overdose?

It is very easy to overdose on this drug, in part because opioids depress breathing to the point of oxygen deprivation while the person is asleep. Mixing alcohol and opioids enhances the effects of both drugs, making it harder for emergency responders to treat the overdose. Alcohol and opioids are two of the most addictive drugs in the United States when used separately, so mixing them can quickly lead to serious health effects, tolerance, dependence, and addiction.

When Is Codeine Treatment Necessary?

It is important to get help and appropriate treatment before purple drank or lean put a person in the hospital. Using this drug cocktail, craving it, seeking it out instead of doing other important tasks, losing money, or experiencing legal problems due to use are all signs that drinking this addictive concoction has become a problem and help is needed. Those suffering from abuse issues may seek help on their own; their loved ones may intervene and ask them to quit and go to a rehabilitation program; or a court could sentence the person to a rehabilitation program involuntarily if they are caught with this combination of drugs.

The best approach to detox is to work with a medical professional to withdraw safely from the substance if it’s used regularly. The supervising doctor may use small doses of benzodiazepines if the primary addiction involves alcohol, or they may prescribe buprenorphine if the addiction primarily involves codeine.

People who are detoxing from opioid addiction may experience pain as a symptom. The supervising physician may use over-the-counter painkillers in specific doses to ease this issue. Clonidine is sometimes used off-label to treat opioid withdrawal symptoms, especially nausea and loss of appetite.

Once detox has been successfully completed, the individual must enter a rehabilitation program. These programs provide group and individual therapy, as well as family therapy and other complementary treatments, to help the person mend relationships, understand addiction, and deal with triggers or stress in a more successful, sober manner.

Treatment is extremely important because purple drank, sizzurp, lean, syrup, and similar concoctions are all very dangerous. Continued use can quickly lead to addiction and overdose. Fortunately, there are many adolescent, young adult, and adult rehabilitation programs that can help people struggling with this addiction.

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