Drug and Alcohol - Opioid Addiction

Lean: What is Purple Drank, is it Addictive, and What are its Effects?

What is lean? A potentially lethal mix of opioids and cough syrup, lean's caused many people to overdose. Learn more about this party drug.

What is Lean?

Table of contents

Written by

Brian MooreBrian Moore

Content Writer

Reviewed by

Jeremy ArztJeremy Arzt

Chief Clinical Officer

June 13, 2023

The Forge Recovery Center

"Lean" refers to a recreational drug concoction that typically includes prescription-strength cough syrup containing codeine and promethazine. It’s mixed with soda or candy for flavor. It is often consumed in combination with alcohol.

Lean is also known by various street names like "Purple Drank," "Sizzurp," or "Dirty Sprite."

The codeine in cough syrup is an opioid drug that can induce sedation and euphoria when consumed in high doses. This feeling is also increased by promethazine, an antihistamine. However, combining these substances (especially with other drugs like alcohol) can depress the central nervous system, resulting in relaxation, slowed breathing, and even death.

What is Lean?

Lean is the street name for a mixture of prescription cough syrup and soft drinks (or pieces of candy). Made popular in southern rap scenes, lean has turned into a relatively cheap party drug.

The prescription cough syrup used in lean usually contains two active ingredients: codeine, an addictive opioid painkiller, and promethazine, a potent antihistamine. While this cough syrup is safe enough to use on its own, abusing it is extremely dangerous … and not just because of codeine.

What is Codeine?

Codeine is an opioid painkiller used to treat mild to moderate pain. It’s also used in cough syrup as a cough suppressant (although it actually isn’t) as well as to treat the pain caused by severe coughing.

While it is an opioid, it’s generally considered to be one of the less potent drugs in that family. That’s not to say codeine can’t be addictive, though: it is.

Mild or not, codeine acts the same way as other opioids. It binds with certain areas on nerve cells called opioid receptors. This alters the way we perceive pain. However, this action also causes an increase in the neurotransmitter dopamine. Dopamine, commonly known as a feel-good chemical, is involved in the body’s reward system. Normally, the body dispenses dopamine in small amounts. Codeine, like other opioids, causes larger amounts of dopamine to be released.

Ins short, this dopamine release is the high many people chase. Aside from addiction, there’s another danger to codeine. In large amounts (or when mixed with drugs like alcohol) codeine can slow down a person’s breathing. This can make a person suffocate, which is how people die from opioid overdoses.

What is Promethazine?

Promethazine is a potent antihistamine. Antihistamines are a non-narcotic class of drugs used to treat allergy symptoms, which is why it’s also used in prescription cough syrup.

Antihistamines work by preventing the body from producing histamines, which cause people to feel itchy, sneeze, have runny noses, and all of the other symptoms of allergies. Promethazine can also combat nausea, vomiting, and motion sickness.

Like codeine, promethazine is benign when used according to instructions. However, when a person abuses lean, they’re also taking very large doses of promethazine. This can make them feel sleepy since promethazine can act like a depressant along with codeine.

Additionally, large doses of promethazine can damage a person’s organs.

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Can You Get Addicted to Lean?

Yes, it is possible to become addicted to Lean. The dangerous combination of codeine and promethazine can lead to opioid addiction with prolonged use.

Opioids have a high potential for addiction due to their effects on the brain's reward system. Regular and prolonged use of lean can result in tolerance, where larger amounts of the drug are needed to achieve the desired effects. This can lead to escalating consumption and an increased risk of adverse effects.

Additionally, abrupt cessation or reduction of lean after prolonged use can lead to withdrawal symptoms, including cravings, restlessness, muscle aches, insomnia, and mood changes. The recreational use of lean is also illegal in many jurisdictions in the US, and its misuse can have severe health consequences. 

Why is Addiction to Lean Common Among US Teens?

Lean addiction due to the recreational use of lean among US teens, has gained attention in recent years. Several factors may contribute to its popularity among this particular demographic:

Cultural Influence

Lean has been glamorized and promoted in certain music genres, particularly hip-hop and rap music. The use of lean has been referenced in song lyrics and music videos, leading to its cultural appeal among teens influenced by popular culture.


Some teens may find lean easily accessible due to the availability of the ingredients. Prescription-strength cough syrup containing codeine and promethazine, the primary components of lean, may be obtained through various means, including sharing or diverting prescriptions or purchasing them illicitly.

Misconceptions About Safety

Some teens may have misconceptions about the safety and risks associated with lean use. They may perceive it as a relatively harmless recreational drug due to its association with cough syrup and the misconception that prescription medications are safer than illicit drugs.

Peer Influence

Peer pressure and the desire to fit in or be accepted among certain social circles can play a role in lean use. Teens may be influenced by their peers who engage in lean consumption, viewing it as a way to bond or be part of a group.

Escapism and Self-Medication

Lean can provide a temporary escape or a way to cope with stress, emotional challenges, or underlying mental health issues. Some teens may turn to lean as a form of self-medication to alleviate emotional pain or seek relief from life's difficulties.


Education and awareness about the dangers of lean use and effective prevention strategies are crucial in addressing the issue among US teens:

  • Implementing comprehensive substance abuse education

  • Promoting healthy coping mechanisms

  • Fostering open communication between parents and teens

  • Providing access to support services

These can all play a role in reducing Lean addiction among this vulnerable population. 

What Are the Side Effects of Drinking Lean?

Drinking lean can have various side effects. These side effects can be both immediate and long-term, and they can vary in severity depending on the dosage and other factors. Here are some potential side effects of drinking lean:

Sedation and Drowsiness

Lean can cause significant drowsiness and sedation, impairing coordination, slowed reaction times, and difficulty staying awake.

Respiratory Depression

Codeine, an opioid, can suppress the central nervous system, including the respiratory system. In severe cases, this can lead to slowed breathing, shallow breathing, or even respiratory arrest.

Gastrointestinal Effects

Lean can cause constipation, nausea, and vomiting.

Cognitive Impairment

Lean can impair cognitive function, including memory, attention, and decision-making abilities.


Drinking lean can cause low blood pressure, which may result in lightheadedness, dizziness, and fainting.

Dependence & Addiction

The combination of codeine and promethazine in lean can lead to physical and psychological dependence, leading to addiction.


Consuming high doses of lean or combining it with other substances, such as alcohol, can increase the risk of overdose. 

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What Are the Signs & Symptoms of Lean Addiction?

Signs and symptoms of lean addiction can vary from person to person, but some common indicators may include:

Compulsive Use of Lean

You may have an intense urge to consume lean regularly and find it difficult to control or stop its consumption.

Increased Tolerance to Lean

Over time, the body may adapt to the effects of lean, leading to the need for larger doses to achieve a high.

Lean Withdrawal Symptoms

When attempting to quit or reduce lean use, you may experience withdrawal symptoms such as:

  • Restlessness

  • Muscle aches

  • Insomnia

  • Irritability

  • Anxiety

  • Sweating

  • Nausea

  • Vomiting

  • Neglecting responsibilities

  • Social Isolation

  • Those struggling with Lean addiction may withdraw from social activities, hobbies, or relationships that were once important to them.

Physical and Psychological Side Effects of Lean

Lean addiction can lead to physical symptoms such as:

  • Drowsiness

  • Impaired coordination

  • Slowed breathing

  • Constipation

  • Mental health issues like depression or anxiety

  • Continued Use of lean despite negative consequences

These signs and symptoms do not necessarily confirm an addiction but are cause for concern. However, suppose you or someone you know is exhibiting these signs and struggling with Lean use. In that case, you must seek professional help from a healthcare provider or addiction specialist for a comprehensive evaluation and appropriate support.

What Are the Withdrawal Symptoms of Lean?

Withdrawal symptoms can occur when a person dependent on Lean attempts to reduce or stop its use. The severity and duration of withdrawal symptoms can vary depending on factors such as the duration and intensity of Lean use, individual physiology, and the method of discontinuation.

However, some common withdrawal symptoms associated with lean dependence may include:

  • Drug cravings can be a prominent withdrawal symptom during the early stages of discontinuation

  • Feelings of restlessness, irritability, and agitation. You may also experience difficulty in managing your emotions

  • Increased feelings of anxiety and depression can accompany withdrawal from lean. Emotional instability and mood swings may also occur

  • Withdrawal from lean use can disrupt normal sleep patterns, leading to difficulty falling or staying asleep.

  • Some individuals may experience muscle aches and pains as part of withdrawal

  • Digestive disturbances such as nausea, vomiting, and diarrhea can occur during lean withdrawal

  • Profuse sweating or cold chills are possible withdrawal symptoms, often associated with the body adjusting to the absence of lean

  • During withdrawal, some individuals may experience increased heart rate and blood pressure

Lean withdrawal can be uncomfortable and, in some cases, potentially dangerous. Suddenly stopping lean use after prolonged and heavy consumption can lead to severe withdrawal symptoms. It is always better to consult professionals to stop using Lean effectively. 

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How Can I Manage Withdrawal Symptoms of Lean?

Managing lean withdrawal symptoms is best done under the guidance of healthcare professionals or addiction specialists who can provide appropriate support and treatment. If you try to do it yourself, you may experience intense cravings, which can be counterproductive when trying to quit abusing lean.

Additionally, quitting any opioid drug on your own is not recommended. This really is a process best left to professionals.

However, here are some general strategies that you can follow to manage Lean withdrawal symptoms:

  • Seek medical assistance: Consult with a healthcare provider or addiction specialist who can evaluate your specific situation and provide personalized guidance. In addition, they may recommend medications or therapies to help manage withdrawal symptoms and support your recovery.

  • Gradual tapering: Instead of abruptly stopping Lean use, a healthcare professional may advise a gradual reduction in dosage over a specific period. This tapering approach can help minimize the severity of withdrawal symptoms

  • Supportive environment: Surround yourself with a supportive network of family, friends, or support groups who can offer understanding, encouragement, and accountability during the withdrawal process.

  • Stay hydrated and eat nutritious meals: Maintaining proper hydration and nutrition during withdrawal is crucial. Focus on consuming a balanced diet, drinking plenty of water, and avoiding substances that can worsen symptoms, such as caffeine or alcohol.

  • Practice stress-reduction techniques: Engage in stress-reducing activities such as deep breathing exercises, meditation, yoga, or hobbies to help manage anxiety and promote relaxation.

  • Get enough rest: Withdrawal symptoms can be physically and emotionally draining. Therefore, prioritize getting sufficient sleep and rest to support your body's healing process.

  • Engage in physical activity: Regular exercise, within your capabilities, can help alleviate some withdrawal symptoms and improve mood. Consult with a healthcare professional to determine suitable physical activities for your situation.

  • Medication-assisted treatment: Sometimes, healthcare providers may prescribe medications to help manage specific withdrawal symptoms. These medications can include non-opioid pain relievers, anti-anxiety medications, or medications that help reduce cravings.

What Are Some Medications That Can Help with Lean Withdrawal Symptoms? 

Self-medicating your way through withdrawal is not advised under any circumstance. Talking to your doctor is the best way forward when managing Lean withdrawal symptoms. The specific medications they will prescribe can vary depending on the severity of withdrawal symptoms and your overall health.

Here are some medications healthcare professionals commonly use in the management of lean withdrawal:


This medication is commonly used to manage anxiety, agitation, sweating, and high blood pressure during opioid withdrawal. It helps to reduce withdrawal-related physical symptoms.

Non-Opioid Pain Relievers

Over-the-counter pain relievers, such as acetaminophen (paracetamol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, may be recommended to help alleviate muscle aches and pains that can occur during withdrawal.

Anti-Anxiety Medications

Medications like benzodiazepines may be prescribed short-term to manage severe anxiety or insomnia during withdrawal. However, these medications are carefully monitored due to their potential for dependence.

Anti-Nausea Medications

If you experience nausea and vomiting during withdrawal, your doctor may also prescribe medications such as ondansetron to help manage these symptoms.


In cases where individuals experience depression or persistent mood disturbances during withdrawal, healthcare professionals may consider prescribing antidepressant medications to provide relief and support mental well-being.

Please remember that a healthcare professional or addiction specialist should determine medication use. Self-medication or using medications without professional guidance can be potentially harmful. Only a healthcare professional can properly assess your situation and recommend the most appropriate medications, dosages, and treatment plans for managing Lean withdrawal symptoms safely and effectively.

What If Someone Has Overdosed on Lean?

If you suspect or witness an overdose on lean or any opioid, it is crucial to take immediate action. Overdoses can be life-threatening, and prompt intervention can make a significant difference. Here are the steps to follow if you suspect an overdose of lean:

  • Call emergency services: Dial emergency services (such as 911 in the United States) or the appropriate local emergency number to seek immediate medical assistance. Provide the operator with clear information about the situation, the substance involved, and the person's condition.

  • Stay with the individual: If it is safe, stay with the person who has overdosed and monitor their vital signs. If they lose consciousness, make sure their airway remains open and clear.

  • Do not leave them alone: Keeping the person awake and responsive is crucial if possible. If they are unconscious or experiencing difficulty breathing, it is essential to perform rescue breathing or CPR (cardiopulmonary resuscitation) if you are trained.

  • Share information with medical professionals: When emergency medical services arrive, provide them with accurate information about the substance involved, the quantity consumed (if known), and any other relevant details. This information will help guide their treatment decisions.

  • Do not induce vomiting: Unless instructed by medical professionals, avoid trying to induce vomiting to eliminate the substance from the body. It is essential to follow the advice of healthcare providers.

Remember, time is of the essence during an overdose situation. Seeking immediate medical attention is critical to increase the chances of a positive outcome. However, it is always better to err on the side of caution and seek professional help, even if you are unsure if an overdose has occurred.

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Lean Addiction is Treatable. The Forge Recovery Center Specializes in Treating Opioid Addiction

Lean is a dangerous blend of opioids and sugary drinks. Individuals seeking detoxification and rehabilitation services for managing their addiction to lean must be cautious while selecting a rehab facility.

The Forge Recovery Center uses evidence-based methods to effectively treat opioid addiction. We’ll help you detox from lean in a safe, comfortable way. Our team will also help you develop the coping mechanisms and tools you need to leave lean abuse behind you.

Want to learn more about lean and how codeine addiction is treatable? Reach out to The Forge Recovery Center today.

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