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What Is Lean? (Purple Drank) – Codeine

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What Is Lean? (Purple Drank)

Lean — also known as purple drank, purple lean, sizzurp, dirty sprite, and lean drink—is a made of combination of prescription-strength cough medicine, soft drinks, and hard, fruit-flavored candy.1,2 The prescription cough syrups used to make lean drink present the most danger because they often contain codeine, an opioid drug.1-4 Another active ingredient in some prescription cough syrups is promethazine, an antihistamine with potentially sedating effects that, in combination with opioids, could markedly impair motor functioning.1,2,5 

Adolescents often get together with friends to make lean. Lean is concocted from a narcotic drug and its excessive consumption can have dangerous consequences.

Codeine is an opiate or opioid drug and is frequently used as a cough suppressant or mild analgesic.4 When codeine is consumed in large doses or for non-prescription purposes, however, it can have extremely harmful effects.4 People may easily lose track of how much of the drug they have consumed because lean is in drink form and because the cough syrup in it may be masked by pleasant or familiar flavors from soda and candy.

Conclusive usage statistics are difficult to come by in part because the whole lean phenomenon is a relatively recent one. Also, as the primary ingredient may be obtained legally with a prescription, it becomes difficult to track its misuse as a component of lean. Making the trend of using lean even more complicated are the many celebrities and professional athletes who have been at the center of news stories about the drug. Their media coverage and tacit endorsement of lean use has made sizzurp a hot topic with the tweens and teens who look up to them and now think that it is safe or cool to use.2

What Are the Side Effects of Lean?

    • Memory problems.
    • Listlessness.
    • Headache.
    • Blurred vision.
    • Dizziness.
    • Nausea.
    • Constipation.

Regular purple drank use can cause additional, widespread health issues. Individuals who use the drug regularly could experience:1,4,5,6

    • Dental decay.
    • Weight gain.
    • Urinary tract infections.
    • Trouble breathing.
    • Irregular heart rate.
    • Seizures.

Though some may believe a substance like lean to be safe because it contains substances regularly prescribed by doctors (cough syrup, antihistamines), those who consume it in the long term or in sufficiently large quantities may be at risk of experiencing dangerous and, in some cases, lethal drug effects. Such health risks are compounded when it is used in combination with other drugs.1 Some cases of coma and death have been reported and attributed to purple drank use.1 The risk of death is highest when combined with other sedative drugs or depressant substances such as alcohol.3

Can I Become Addicted to it?

The highly addictive nature of opioids is due, in part, to their rewarding, euphoric effects. Opioids should only be used in a therapeutic context under the direction of a physician and should only be taken as prescribed to mitigate some of this addictive potential.

According to the 2018 Monitoring the Future Report published by the Drug Enforcement Agency, 2.8% of 8th graders, 3.3% of 10th graders, and 3.4% of 12th graders abused cough and cold medicines in the previous year for recreational purposes.8

Chronic use of opioids, such as the codeine found in purple drank, can lead to the development of drug tolerance and dependence.9 As tolerance mounts, people may find themselves needing to consume increasing amounts of the drug to experience the desired effects.9 This ramping up of drug taking behavior can drive the development of significant physiological dependence. Opioid-dependent people are likely to experience a range of unpleasant withdrawal symptoms should they go without the substance for too long.

In the beginning stages of withdrawal from codeine, an addicted person may experience:4,6

    • Anxiety.
    • Agitation.
    • Difficulty sleeping.
    • Muscle aches.
    • Increased tearing from the eyes and a runny nose.
    • Sweating.
    • Chills and goosebumps.
    • Increased heart and breathing rate.

If a person has used purple drank for a long time or in high doses, symptoms may progress in intensity beyond the period of early withdrawal. These later, more unpleasant withdrawal symptoms may include:4,6

    • Nausea.
    • Vomiting.
    • Diarrhea.
    • Abdominal cramping.

To avoid or end withdrawal symptoms, people addicted to the drug will often return to using purple drank or other opioid drug, thus creating an endless cycle of substance use that can destroy their health.

Treating A Lean (Purple Drank) Addiction


Many people are surprised to learn what drinking lean can do to their bodies, yet, even after learning about the harmful side effects, they continue to use. Seeing their favorite celebrities using the concoction and boasting about their experiences with the drug often encourages the behavior. When continued use of lean leads to addiction, professional addiction treatment can help.

Because the withdrawal symptoms associated with opioid dependence are so uncomfortable, many people choose to go through withdrawal in an inpatient detox setting and continue on with a longer duration of addiction treatment. As part of a medical detox protocol, patients may receive certain medications to help them withdraw as comfortably as possible. Though codeine is a relatively low-potency opioid drug, should the acute opioid withdrawal syndrome be significantly severe, medications such as methadone, buprenorphine, and clonidine may be administered to manage symptoms.9

If you are ready to get treatment for compulsive lean use, consider these options:

    • Detoxification: A supervised medical detox program can provide short-term inpatient treatment to help you get through the first few hours or days as comfortably and safely as possible. Many people choose to transition from a detox program to an inpatient addiction treatment program to continue their recovery
    • Inpatient treatment: Inpatient programs require you to live at a treatment facility where you receive around-the-clock care. Inpatient programs may be best for people whose addiction is relatively severe and would benefit from the added supervision provided in an inpatient setting.
    • Outpatient treatment: During outpatient treatment, you attend treatment anywhere from 2 to 8 hours a day for 2 to 5 days a week, and return to your home or other sober living environment outside of treatment hours.
    • 12-step groups: 12-step groups such as Narcotics Anonymous help you progress through the steps of recovery by incorporating member stories, helpful literature, and a sponsor support system.
    • Non-12-step support groups: Similar to 12-step groups but often with a more secular-based recovery philosophy, other support groups can help you overcome your addiction in a self-paced, group environment.

Whether it’s called lean, purple drank, sizzurp, or any other name, this concoction is a drug that can be lethal in high doses or when mixed with other sedative drugs or alcohol. Repeated use can cause serious health problems and even death.

Calling for Help for Your Teen?

Making the decision to ask for your help for you child can be a stressful one, but it can be made less so by understanding what will happen during the call. Likely, you’ll be asked for answers to the following types of questions:

  • When did your child began using the substances?
  • How long has the substance use has been going on?
  • What is the dose/average amount they are consuming?
  • Have you seen any major changes in your child (e.g., Have they become violent, had thoughts of self-harm, become depressed?)?
  • Does your child have any diagnosed mental health disorders?
  • Are they are currently taking any medications?
  • Do they have any physical disabilities or limitations?
  • Have they been in treatment for substance use before now?
  • Does anyone else in the household use substances?
  • Whether you have current insurance for your child? (Have your insurance card on hand to provide details you can give the admissions consultant so they can help to determine your coverage).

Verify your insurance coverage

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Senior Medical Editor
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating him to seek a clinical psychiatry preceptorship at the San Diego VA Hospital’s Inpatient Alcohol and Drug Treatment Program. In his post-graduate clinical work, Dr. Thomas later applied the tenets he learned to help guide his therapeutic approach with many patients in need of substance treatment. In his current capacity as Senior Medical Editor for American Addiction Centers, Dr. Thomas, works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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