“Lean” refers to a dangerous, illicit drink typically made by mixing prescription cough syrup with a soft drink and sometimes hard candy. It is also known as “purple drank,” “sizzurp,” or “dirty Sprite.” This beverage originated in the Southern United States as early as the 1960s and gained popularity within hip-hop culture.
What Lean Is Made Of
The primary active ingredients in “lean” are codeine, an opioid, and promethazine, an antihistamine. Codeine functions as a pain reliever and cough suppressant, producing sedative properties. Promethazine contributes to the sedative effects and also acts as an anti-nausea agent. When combined, these two substances amplify the depression of the central nervous system, leading to feelings of relaxation and drowsiness. Codeine is classified as a controlled substance.
Why Lean Causes Addiction
“Lean” can lead to addiction primarily because of codeine, which is an opioid. Codeine affects the brain’s reward system by binding to opioid receptors and increasing dopamine levels. This surge of dopamine creates feelings of euphoria and pleasure, reinforcing the desire to use the substance again. Repeated use of codeine leads to tolerance, meaning larger amounts are needed to achieve the same effects. As tolerance develops, physical dependence can occur, where the body adapts to the drug’s continuous presence. When use stops, uncomfortable withdrawal symptoms emerge, making it difficult to stop without facing this discomfort. This cycle of physical and psychological reliance contributes to the addictive nature of “lean.”
Recognizing Addiction
Recognizing addiction to “lean” involves observing a combination of physical, behavioral, and psychological indicators. Physical signs can include excessive drowsiness, slurred speech, constricted pupils, impaired motor skills, and changes in sleep patterns. Individuals may also experience nausea, dizziness, or a pale or bluish tint to their skin.
Behavioral changes often include neglecting responsibilities, secretiveness, and a loss of interest in activities once enjoyed. Financial problems, continued substance use despite negative consequences, and seeking the drug compulsively are also common. Psychological signs might manifest as mood swings, increased anxiety, agitation, or depression.
Risks to Health
Using “lean” carries serious health risks. Acute risks include slowed heart rate and breathing, which can lead to life-threatening respiratory depression and overdose. Overdose symptoms can manifest as confusion, cold and clammy skin, a weak pulse, or loss of consciousness. Seizures are also an acute risk.
Long-term use can result in chronic issues such as liver and kidney damage, especially if acetaminophen is also present in the cough syrup. Severe constipation is a common side effect of opioid use. Dental problems, including tooth decay, can develop due to the high sugar content in the mixture and poor hygiene. Consistent use can exacerbate existing mental health conditions, leading to increased anxiety or depression.
Finding Support and Treatment
Individuals struggling with “lean” addiction can find support through professional medical and psychological intervention. Treatment often begins with medically supervised detoxification to manage withdrawal symptoms safely. Medications may be used during detox to ease discomfort.
Following detoxification, behavioral therapies are typically recommended. Cognitive-behavioral therapy (CBT) helps individuals understand the underlying causes of their substance use and develop healthier coping strategies.
Medication-assisted treatment (MAT) is another effective approach for opioid addiction, utilizing medications like buprenorphine, methadone, or naltrexone in combination with counseling. These medications can help reduce cravings and prevent relapse, supporting long-term recovery.