Lean is also called purple drank, sizzurp, or syrup. While it was once exclusively associated with rap music and urban teenagers, it’s moved to the mainstream. Understanding what it is and how it works is crucial for parents.
What Is Lean?
No one can walk into a liquor store or pharmacy and walk out with lean, but you could put together all the ingredients you need with one quick trip (and some prescription medication from a doctor). Mix up the elements, and you have a drink capable of changing how you feel, act, and react.
Lean recipes vary widely, but most contain cough syrup, soda, hard candy, and alcohol. It’s traditionally served in a white Styrofoam cup.
Key Facts About Lean
- In a study of rave-goers, researchers found that almost 16% have ever used lean, and 14% would use it if it were offered to them by a friend.
- Lean drinks almost always include cough syrup or codeine tablets. But other ingredients can vary.
- Long-term lean use is associated with side effects like dental decay, constipation, and weight gain.
- Codeine, used in lean mixtures, is a prescription painkiller in the opioid class, well known for causing substance abuse and addiction.
How It’s Made: Common Ingredients
Lean recipes can vary, but most include the following ingredients:
- Cough syrup with codeine, dextromethorphan, and/or promethazine: Codeine is an opioid drug that makes people feel drowsy and euphoric, but it can also make them feel queasy at high doses. Promethazine blocks nausea, so people can drink more with no ill effect. Dextromethorphan causes out-of-body experiences and hallucinations.
- Soda: Some recipes call for purple-tinged sodas, but others require clear drinks (like Sprite).
- Candy: Hard candies give the drink its distinctive color. Some candies add a fruity flavor.
- Alcohol: Some cough syrups contain alcohol. But when it’s not present, users add a clear alcohol like vodka instead.
The amounts of each ingredient can vary. Some people make entirely different versions of the drink.
History & Statistics
In the early 1990s, rap singers started discussing the drink in their songs, and some offered lyrics detailing the specific benefits of their drinks.
In one study of lyrics, researchers found that singers discussed lean’s connection to the following:
- Other drugs
- Sexual activity (including benefits)
- Mental health
In general, these lyrics made lean sound like a perfect alternative to alcohol or other drugs. Listeners could walk away with real recipes they could use to build their own beverages at home.
One of the leading voices singing about purple drank allegedly died from an overdose of his creation, but even that hasn’t stopped others from trying it.
Now, researchers say lean has moved mainstream, and it’s popular among all sorts of people. In a study of teenage dance party attendees, 15.5% had ever used lean.
In a study of rave-goers, researchers found that almost 16% have ever used lean, and 14% would use it if it were offered to them by a friend.
Addiction Potential & Warning Signs of Lean Abuse
While some people associate lean with a party situation, the drug’s ingredients are dangerous. Some people start using lean with friends and develop an addiction they nurture in private.
The codeine used in lean is an opioid, well known for causing addictions. Opioids work by latching to brain receptors and releasing dopamine. In time, people need opioids for dopamine, as their cells won’t produce it independently.
If you’ve been using lean regularly, you could have an addiction. Ask yourself these questions:
- Do you crave lean almost all the time?
- Do you spend most of your day plotting how to get and use more lean?
- Do you keep using lean even when it makes you sick, or do you face consequences for using it?
- Do you spend most of your money getting and using lean?
- Do you need a dose of lean in the morning to get you going?
- Do you find that your regular lean dose isn’t strong enough?
Parents may notice that their children seem sedated, confused, or frightened. Their breath may smell overly sweet or tinged with alcohol. And they may feign frequent coughs and sicknesses, so you’ll buy them more cough syrup.
Side Effects: How Lean Affects the Body
Plenty of people believe that mixtures like purple drank are safe. After all, they contain household substances and prescription medications. Unfortunately, this combination comes with plenty of hazards.
Ingredients like alcohol pass out of the body within hours. But codeine can persist for four hours or longer. Dextromethorphan can last for 24 hours or longer.
Short-Term Side Effects
Short-term side effects include the following:
- Blurred vision
- Dissociative sensations
In large doses, lean can cause severe sedation. Combining alcohol and codeine is particularly dangerous, as it can lead to life-threatening overdose symptoms (like slow or absent breathing).
Opioids caused 68,000 deaths in 2020 alone. Anyone who abuses purple drank should remember that they are using a drug that causes widespread death.
Long-Term Side Effects
Long-term lean use is associated with the following:
- Dental decay: Cough syrup is sticky and designed to coat irritated throats. That action puts sugar in contact with teeth, and carbonation intensifies the damage.
- Constipation: Codeine and other opioids slow down the digestive tract. Some people find it’s impossible to empty their bowels without medications or enemas when they are taking opioids.
- Weight gain: Sipping on sweet, sugary drinks all day can quickly lead to significant weight gain.
|Short-Term Side Effects||Long-Term Side Effects|
|Blurred vision||Missing teeth|
|Dizziness||Reliance on enemas or laxatives|
|Lack of coordination||Weight gain|
|Hallucinations||Cravings for opioids|
|Slurred speech||Opioid use disorder|
|Sweet-smelling breath||Higher risk of transitioning to stronger opioids (like heroin)|
Combining Lean With Other Substances
Lean is a combination drink that includes drugs from several different classifications. Some people add to the danger by mixing lean with other substances.
The opioid within lean in a central nervous system depressant that can interact with almost every other kind of drug. Alcohol works in the same way. The antihistamine and anti-nausea ingredients can interact with common drugs too.
Lean can interact with the following substances:
- Opioids like fentanyl and oxycodone
- Sedatives like lorazepam and diazepam
- Sleep aids
Symptoms of Withdrawal
The opioid in lean can cause withdrawal symptoms in regular users who quit abruptly. Those symptoms can be so severe that people return to drinking lean to make the misery stop.
Common opioid withdrawal symptoms include the following:
- Muscle aches
- Watery eyes
- Runny nose
Treatment Options for Lean Addiction
Few detailed studies have been published on lean addiction treatment. But since it’s commonly made from codeine, an opioid, treatment options for opioid use disorder can be effective. Your program might include the following elements:
Quitting a longstanding lean habit is painful and dangerous. Medical detox is different. Treatment teams offer medications to help your brain cells adjust to the absence of lean. You can get sober with this method without feeling so sick that you’ll relapse.
In a medical detox program, you’ll be surrounded by people who want you to get better. And no ingredients from lean are allowed to be brought in, so your relapse risks are low.
Inpatient Drug Rehab
In an inpatient drug rehab program, you move away from home and into the facility. You’ll spend all day working on your addiction, far from the temptations that face you at home.
Traditional talk therapy, or behavioral therapy, involves working with a trained professional to understand why you started drinking lean and what might tempt you to relapse. Your doctor can use several types of therapies, including dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT), to give you the insights and tools you need to stay sober.
Frequently Asked Questions About Lean
We’ve compiled some of the most frequently asked questions about lean.
Yes. Lean typically involves codeine, an opioid painkiller. All medications in this class come with addiction risks.
Lean typically includes cough syrup, soda, candies, and alcohol. People mix the ingredients and serve the drink in white, Styrofoam cups.
Not exactly. Codeine is a controlled substance. You must have a prescription to get these cough syrups from a pharmacy. Using these medications without a prescription isn’t legal.
Lean’s ingredients leave your body at different intervals. The alcohol moves out first, passing within a few hours. Dextromethorphan can last for 24 hours or longer.
Yes, lean can lead to overdose. It occurs due to the codeine in lean, and this risk is exacerbated by the presence of alcohol in many concoctions.
- Palamar J. Use of lean among electronic dance music party attendees. American Journal on Addictions. May 2019. 28(5):1-6. DOI:10.1111/ajad.12897
- Miuli A, Stigliano G, Lalli A, et al. "Purple Drank" (Codeine and Promethazine Cough Syrup): A Systematic Review of a Social Phenomenon with Medical Implications. J Psychoactive Drugs. 2020;52(5):453-462.
- Tettey N, Siddiqui K, Llamoca H, Nagamine S, Ahn S. Purple drank, sizurp, and lean: Hip-hop music and codeine use, a call to action for public health educators. International Journal of Psychological Studies. 2020. Vol. 12, No. 1. doi: 10.5539/ijps.v12n1p42
- Resurgence of abuse of purple drank. National Drug Intelligence Center. Published February 2011. Accessed June 21, 2023.
- Opioid data analysis and resources. Centers for Disease Control and Prevention. Published June 2022. Accessed June 21, 2023.
- Shah M, Huecker MR. Opioid Withdrawal. [Updated 2023 Apr 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.