What Is Lean (aka Purple Drank)?

How Is Lean Made?

Lean or “Purple Drank” is typically created through the combination of:

1. Prescription-strength cough medicine that contains codeine (a prescription opioid) and promethazine (an antihistamine)
2. Hard candy
3. Soda (usually Sprite)

Actavis, the main pharmaceutical company producing codeine-promethazine cough syrup, discontinued production in 2014 due to the syrup’s repeated abuse and connection to overdoses. As a result, very few companies make codeine-promethazine cough syrups now.

While getting a prescription is still possible through doctor shopping or getting multiple prescriptions at once, many pharmacies make this difficult by carefully tracking who fills codeine-promethazine cough syrup prescriptions.

These restrictions have led many lean users to obtain the syrup through the black market or use over-the-counter cold medicines that contain dextromethorphan for its similar effects.

Who Is Affected by Lean Abuse?

While lean abuse began in the rap and hip-hop music scene, its use has since spread throughout the South and has risen in popularity with non-musicians.

According to research from the University of North Carolina at Greensboro, lean abuse is more common in men than women.

Additionally, research shows that individuals with mental health conditions (such as depression or anxiety) are more likely to use a substance like lean to curb the side effects of their mental illness.

Regarding race, the same study reported the use of lean tends to be high in Hispanics (15.6%) and Native Americans (16.7. In comparison, use was lower in Asian Americans (5.1%), African Americans (5.4%), and Caucasians (6.1%).

Reasons People Abuse Lean

Like most other opiates, codeine-laden lean has a relaxing and euphoric effect on users.

Lean users sometimes view codeine-promethazine cough syrup as “better” than using opiates like heroin, as codeine is in liquid form and can be legally obtained through prescription.

For many lean users, their first exposure to the mixture has been through rap and hip-hop music. Lean is often mentioned in the lyrics as a “cool” substance to abuse or a way to relax.

Some rap artists have claimed lean helped with their musical creativity. DJ Screw, who popularized lean in the 90s, often said the mixture inspired his chopped-and-screwed style of hip-hop music.

Unfortunately, codeine is just as addictive as other opioids and leads to the same physical dependence and addiction.

History of Purple Drank

Lean first became popular with blues musicians in the 1960s in Houston, Texas, favored for its soothing effects or swooning euphoria.

In the 60s, lean first began as Robitussin mixed with beer. By the 80s and 90s, lean’s formula changed to codeine-promethazine cough syrup, soda, and hard candy.

Lean’s use had stayed confined to Houston until American rapper DJ Screw released songs in the 90s mentioning the drink, exposing the wider music scene to the mixture. Unfortunately, DJ Screw died of lean-related causes in 2000.

As the use of lean began to spread in the South, notable songs like Three 6 Mafia’s single “Sippin’ on Some Syrup,” featuring UGK, brought the term “purple drank” to a nationwide audience in 2000.

By 2006, the Drug Enforcement Administration (DEA) had focused on cough syrup abuse throughout the South.

Lean is still used today, although its formulation sometimes changes to account for the scarcity and restrictions around codeine-promethazine cough syrup.

Some legal products based on lean have appeared, like the Houston-based beverage “Drank,” made with valerian root, rose hips, and melatonin for relaxation.

Other names for lean include:

• Purple Drank
• Sizzurp
• Syrup
• Texas Tea
• Purple Jelly
• Purple Stuff
• Purple Tonic
• Sip-sip
• Dirty Sprite
• Oil
• Player Potion
• Purp
• Barre

Side Effects of Lean Abuse

Because lean is a mixture of several powerful substances, the side effects of lean use can be alarming and dangerous.

Common side effects of lean abuse include:

• Slowed heart rate and breathing
• Blurry vision
• Hallucinations
• Loss of motor functions
• Restlessness
• Drowsiness
• Dry mouth
• Nausea
• Vomiting
• Fever
• Sweating
• Difficulty urinating
• Confusion
• Dental decay
• Seizures

Dangers of Lean Abuse

The two active ingredients of prescription cough syrups pose several dangers: promethazine is a central nervous system (CNS) depressant, and codeine is a respiratory depressant.

Respiratory depressants can cause slow and shallow breathing, which can prevent enough oxygen from entering the lungs and cause carbon dioxide to build up in the bloodstream.

When carbon dioxide bloodstream levels get too high, there is an elevated risk of life-threatening symptoms like:

• Stopped breathing (respiratory arrest)
• Heart attack
• Brain damage due to insufficient oxygen
• Slow heart rate
• Coma
• Death

In addition, the mixture of soda, candy, and cough syrup to produce lean is often haphazard and poorly measured. If too much cough syrup is added to the mixture, the risk of overdose increases.

Another common practice is mixing lean with large quantities of alcohol, which only increases the risk of overdose and respiratory depression.

Can You Get Addicted to Lean?

While the antihistamine promethazine has relatively low addiction rates, the opioid codeine is highly addictive. Codeine binds powerfully with opioid receptors in the brain, quickly causing physical dependence and addiction in lean users.

Aside from the addictive nature of opioids, the mixture of lean combines highly euphoric and sedating effects and the potent sugar high from soda and hard candy.

Many lean users report using the mixture to relax and, over time, start to develop a dependence on the drug to relax and feel good.

Celebrity Lean Abuse

Many prominent music artists have discussed abusing lean in their songs and in interviews over the past few decades.

DJ Screw protégé, Big Moe, produced the albums “City of Syrup” and “Purple World” based on the drink. Sadly, he passed away in 2007 from a heart attack speculated to be related to lean abuse.

American rapper Fredo Santana frequently referenced lean in his music until his death in 2018 from a seizure connected to liver and kidney problems caused by his lean addiction.

Swedish rapper Yung Lean was hospitalized in April 2015 due to an overdose stemming from an addiction to Xanax, cocaine, and lean.

American rapper Future spoke publicly about quitting lean, notably voicing his disappointment that American rapper Juice Wrld was influenced to try lean because of Future’s music. Juice Wrld would tragically die of a codeine overdose in 2021.

Treatment for Lean Addiction

The treatment for lean addiction is similar to the methods used in prescription opioid addiction. Depending on the patient’s unique needs, they will either enter inpatient rehab, an intensive outpatient program (IOP), or a partial hospitalization program (PHP).

Medical detox may be required for patients experiencing flu-like withdrawal symptoms common to opioid withdrawal. However, medication-assisted treatment can manage withdrawal symptoms like buprenorphine, methadone, and naltrexone.

With all addiction treatment options, one-on-one therapy and group therapy will be required. Cognitive behavioral therapy (CBT) is one of the most common psychotherapies used, as it helps addicts identify and redirect negative, drug-seeking behavior for better long-term recovery.

Getting Help for Lean Abuse

Addiction to drugs containing opioids can be challenging to address, but it’s not impossible. If you or a loved one is addicted to drinking lean, treatment centers and healthcare providers are ready to help you regain control over your drug abuse.

You can find a treatment center that best meets your needs by using SAMHSA’s online treatment locator or by calling 1-800-662-4357.