Medically reviewed by Alan Carter, PharmD
Written by Zawn Villines
Lean is a mixture of codeine and other ingredients, such as soda and candy. It is sometimes called purple drank or sizzurp. Several rappers have promoted lean as both a recreational drug and a source of creative inspiration.
However, lean can be deadly in high doses, and chronic use may lead to codeine addiction.
Keep reading to learn more about lean, including its effects and how it can be both addictive and deadly.
What is lean?
Lean is a very sweet drink that blends soda with cough syrup containing codeine. Some formulas also add candy or sweetening syrup. Users may also mix in promethazine, which is an antihistamine that may strengthen the effects of codeine and make a person feel relaxed and sleepy.
High doses of codeine and promethazine can induce hallucinations and vivid dreams or nightmares. Many users take the drug specifically for this reason. They feel that the hallucinations support creative thinking.
Origins and history
Purple drank dates back to at least the 1990s. Its public birth took place in the music scene, with musicians including Justin Bieber, Lil Wayne, and the hip-hop group Three 6 Mafia reportedly using or singing about the drug.
The authors of a 2014 analysis assert that the drug first became popular in the rap and hip-hop scene in Houston, Texas.
The same analysis found a correlation between a person’s taste in music and their likelihood of using lean. Students who preferred rap or hip-hop and rock or alternative music were more likely to use the drug.
This association was particularly significant for fans of rap and hip-hop. In addition, males and users of other drugs had a much higher chance of using lean.
Codeine is an opioid, and the opioid addiction crisis has reached epidemic levels in the United States.
According to the Centers for Disease Control and Prevention (CDC), more than 70,000 people died from drug overdoses in 2017, and 68% of these overdoses involved opioids.
As with other opioids, codeine can relieve pain and make a person feel more relaxed. Many people feel sleepy when using codeine. Adding promethazine to the mix may increase feelings of sleepiness and relaxation.
Some other effects of lean may include:
- altered states of consciousness, including hallucinations and changes in the way that a person thinks
- fatigue, depression, and cloudy thoughts
- poor judgment
- less coughing, as codeine is a cough medication
- a decrease in congestion because of the antihistamine effects of promethazine
Short-term risks and side effects
The short-term side effects of lean include:
- pregnancy complications, such as birth abnormalities or injury to a developing fetus
- slow breathing that may become life threatening in people with certain conditions, such as sleep apnea
- confusion and changes in consciousness
- difficulty driving, completing tasks at work, and operating heavy machinery
- nausea or vomiting
- allergic reactions, in some people
- overdose at high doses or when in combination with other drugs
- blurred vision
- inability to urinate
Effects with alcohol and other drugs
Using other drugs with lean may make its side effects worse, as well as causing additional side effects.
Mixing alcohol with codeine, for example, can increase the risk of severe drowsiness, poor judgment, breathing problems, and life threatening overdose.
Using any drug with lean may increase the risk of liver or kidney damage.
Long-term risks and side effects
One of the most significant side effects of long-term use of lean is addiction. Addiction also leads to an increased risk of overdose because a person may need to use progressively more purple drank to get the same effects that they once got with a lower dose.
Some other long-term risks of lean include:
- infertility and changes in the body’s ability to produce hormones, such as testosterone
- changes in libido
- sexual dysfunction
- behavior and personality changes
- organ damage
As lean slows down activity in the brain and nervous system, taking it with other drugs that have sedating effects can be especially harmful.
Anti-anxiety drugs, such as benzodiazepines, sleeping pills, and sedatives, are especially dangerous. Using other opioids, such as fentanyl or heroin, increases the risk of breathing problems and fatal overdose.
Is it addictive?
People who think that they have an addiction to lean are usually addicted to its active ingredient, which is codeine. Codeine, in the same way as other opioids, is highly addictive.
The sweet flavor of other additives, such as soda and candy, can entice users to try the drink, furthering the risk of addiction.
Promethazine, a popular additive to lean, intensifies the effects of codeine.
Some users may also intentionally misuse promethazine because of its sedative effects. Doing this can trigger an addiction to both promethazine and codeine.
Some signs that a person may have an addiction to either lean or the drugs that it contains include:
- needing lean to feel normal
- spending significant time and money trying to access lean or its ingredients
- continuing to use the drug in spite of negative consequences, such as health issues or relationship problems
- trying to stop using lean but being unable to do so
- using lean on a regular, daily basis
The treatment for codeine addiction is similar to the treatment for most other addictions.
People who are reluctant to quit and those who have very severe addictions or chronic health problems may need serious medical treatment.
Some other strategies that may help include:
- Addiction support groups: Peers can provide support to help people with a drug use disorder feel less alone and offer practical insight for coming off the drug. Many people find 12-step programs to be very helpful. Newer models of support, including internet support forums, can also help.
- Therapy: Therapy can help a person understand what triggered their use of the drug, in addition to offering practical support as they work to quit it.
- Medication: Some people use lean to cope with an underlying medical condition. Medication, such as antidepressants or anti-anxiety medication, may offer safer help.
- Lifestyle changes: Some people find that avoiding people who use lean helps them stay clean. Others find that exercise and dietary changes can ease withdrawal symptoms.
Although popular culture often portrays lean as a harmless, sugary way to spur creative thinking, it is a potent and potentially addictive drug.
Users can die of codeine overdose or from organ failure due to chronic overuse.
The high risk of addiction means that lean is not safe as a recreational drug.
People who think that they may have an addiction to lean should seek medical assistance.