The recreational substance known as “Lean,” also called Purple Drank or Sizzurp, has a distinct effect on the digestive system, primarily causing constipation. This condition involves a significant slowing of bowel movements. This effect is a direct result of the pharmaceutical ingredients contained in the mixture and is a well-documented side effect of that class of medication. The slowed transit time in the colon leads to hardened stools and difficulty with elimination.
Understanding Lean and Its Active Ingredients
Lean is a concoction typically made from mixing prescription-strength cough syrup with a soft drink, often accompanied by hard candy for flavor. The syrup contains two primary pharmaceutical components. One is codeine, which belongs to the opioid class of medications. The other is promethazine, an antihistamine that acts as a sedative and anti-nausea agent.
While promethazine adds to the overall sedating effect of Lean, codeine is the main driver of the digestive system changes. Codeine is a mild opioid analgesic used medically for pain relief and cough suppression. The amount of codeine consumed in a typical dose of Lean is often much higher than the dosage used for therapeutic purposes. This increased concentration heightens the drug’s impact on the body, including its profound effect on gastrointestinal motility.
How Opioids Impact Bowel Function
The constipation caused by Lean is a direct result of the codeine acting on the enteric nervous system (ENS), the network of nerves embedded in the wall of the gastrointestinal tract. Codeine, like other opioids, binds to mu-opioid receptors, which are abundant throughout the digestive system. Activating these receptors has an inhibitory effect on the natural function of the gut.
This binding primarily causes two major physiological changes that lead to constipation. First, it inhibits peristalsis, the wave-like muscular contraction that moves food and waste through the digestive tract. Slowing these propulsive movements increases the transit time of fecal matter through the colon dramatically. Second, codeine reduces the secretion of water and electrolytes into the intestinal lumen. This decreased fluid secretion, combined with the longer transit time, allows the large intestine to absorb an excessive amount of water from the stool. The resulting fecal matter becomes hard, dry, and difficult to pass, a condition medically known as opioid-induced constipation (OIC).
Managing Drug-Induced Constipation
Managing drug-induced constipation requires specific steps to counteract the effects of the opioid. Increasing fluid intake is essential, as hydration helps keep the stool softer and easier to pass. Water helps compensate for the excessive absorption that occurs in the colon due to the opioid’s action.
Incorporating sufficient dietary fiber is generally recommended to add bulk to the stool. However, for opioid-induced constipation, bulk-forming laxatives are often avoided because the slowed motility can cause the increased bulk to worsen abdominal discomfort. Instead, maintaining a balanced intake of soluble and insoluble fiber from foods like fruits and vegetables supports overall bowel health. Gentle physical activity, such as walking, can help stimulate the muscles of the digestive tract, promoting motility. If severe constipation persists, medical intervention involving specific laxatives is often necessary.