“Lean,” also known as “purple drank” or “sizzurp,” is a concoction made by mixing prescription-strength cough syrup with a soft drink, often with the addition of hard candy. The primary active ingredients are the opioid codeine and the antihistamine promethazine, both central nervous system (CNS) depressants. This article focuses on the pharmacological timeline and duration of these two substances combined in high, non-therapeutic doses.
Chemical Makeup and Mechanism of Action
The mixture contains codeine, an opioid, and promethazine, a first-generation antihistamine. Codeine is a prodrug, largely inactive until the liver enzyme CYP2D6 metabolizes it into morphine. Morphine is the potent metabolite that binds to mu-opioid receptors, producing the euphoric, analgesic, and sedative effects of the high.
Promethazine acts as an H1-receptor blocker, responsible for its significant sedative properties. It also exhibits anticholinergic effects, which contribute to its use as an anti-nausea medication and enhance CNS depression. When combined, promethazine intensifies codeine’s depressant effects, creating a synergistic action that increases intoxication and the risk of harm.
Typical Timeline of Effects
The noticeable psychoactive effects typically begin quickly after ingestion, usually within 20 to 45 minutes, as the substances are rapidly absorbed from the digestive system. The initial feelings often include relaxation, lethargy, and a dissociative sense of euphoria.
The peak effect, when the high is strongest, generally occurs between 1.5 and 3 hours following consumption. During this phase, users experience the most intense sedation and impaired motor skills due to the maximum concentration of the active metabolite, morphine, and promethazine in the bloodstream. The total duration of noticeable psychoactive effects typically lasts approximately 4 to 6 hours.
Following the peak, the effects begin to gradually subside as the body processes and eliminates the drugs. Although the primary high fades after about six hours, residual drowsiness and impaired coordination may persist for a longer time. Codeine is mostly cleared from the body within 16 hours, but its metabolites can be detectable for up to 24 hours.
Variables Affecting the Length of the High
The standard timeline changes significantly based on several individual and circumstantial factors.
Dosage and Metabolism
The dosage and concentration consumed directly affect the duration, as a larger dose requires more time to metabolize. A user’s individual metabolic rate, specifically the function of the CYP2D6 enzyme, plays a substantial role in how quickly codeine converts to morphine. “Ultra-rapid metabolizers” convert the drug efficiently, leading to a shorter onset but increased toxicity risk, while “poor metabolizers” may experience a minimal high.
Tolerance and Drug Interactions
Tolerance built up from repeated use reduces the perceived duration of the high, requiring higher doses for the same effect. The presence of other central nervous system depressants, such as alcohol or benzodiazepines, is a dangerous factor. Combining multiple depressants slows the body’s natural processes, extending intoxication and dramatically increasing the risk of respiratory failure.
Acute Health Risks of Lean Use
The combination of codeine and promethazine poses immediate and severe health hazards, primarily due to their synergistic depressant action on the central nervous system. The most significant acute risk is respiratory depression, where breathing becomes dangerously slow or shallow, potentially leading to a lack of oxygen in the brain and major organs. This risk is heightened because promethazine intensifies codeine’s ability to suppress the body’s respiratory drive.
The severe sedation caused by the mixture can lead to profound drowsiness, confusion, and loss of consciousness, which escalates the danger of accidental overdose. Overdose symptoms include extreme sleepiness, pinpoint pupils, and blue-tinged skin or lips. Mixing lean with any other CNS depressants, including alcohol, significantly compounds the risk of fatal respiratory arrest.