Lean, often recognized as “Purple Drank” or “Sizzurp,” is a dangerous, homemade recreational mixture that has gained notoriety, particularly within popular culture. The drink is characterized by its base of prescription-strength cough syrup, which is combined with soft drinks and sometimes candy to mask the medicinal taste. This concoction is consumed recreationally for the feelings of euphoria and dissociation it induces. The term “lean” comes from the way users often appear to slouch due to the intense sedative effects of the drug mixture.
Core Ingredients and Legal Classification
The Lean mixture’s power comes from its primary active components: codeine and promethazine, found in prescription-grade cough syrups. Codeine is an opioid analgesic that acts on the central nervous system to relieve pain and suppress coughs, making it responsible for the euphoric and addictive properties of the mixture. Promethazine is a first-generation antihistamine that intensifies sedation and reduces nausea, a potential side effect of the opioid.
Lean is considered a narcotic because its main ingredient, codeine, is an opioid and classified as a controlled substance. The U.S. Drug Enforcement Administration (DEA) places codeine-containing cough preparations into Schedule III or Schedule V, depending on the concentration. For example, cough syrups containing not more than 200 milligrams of codeine per 100 milliliters are often classified as a Schedule V controlled substance. This legal scheduling means that obtaining the prescription-only medication without a valid prescription or mixing it for recreational use constitutes illegal drug diversion and possession.
Immediate Physiological and Psychoactive Effects
The effects of Lean begin when codeine is processed in the liver and metabolized into morphine by the CYP2D6 enzyme. Morphine is a potent opioid that binds to mu-opioid receptors in the brain, triggering central nervous system (CNS) depression. This action slows brain activity, leading to a profound sense of relaxation and euphoria. The user often experiences an altered state of consciousness, dissociation from the body, and slowed motor skills.
Promethazine enhances the sedative effects of the opioid, increasing drowsiness and mental clouding. This combination of CNS depressants leads to physical manifestations such as slurred speech, constricted pupils, and difficulty with coordination. The high doses consumed in Lean intensify the typical effects of codeine, such as dizziness and lightheadedness. The psychoactive effect is the body and mind slowing down to dangerous levels.
Acute and Chronic Health Dangers
The most immediate life-threatening danger of Lean consumption is acute respiratory depression, the primary cause of fatal overdose. As a CNS depressant, codeine suppresses the involuntary functions that control breathing. At high recreational doses, the respiratory rate can slow until a person stops breathing entirely. This risk is heightened when Lean is mixed with other CNS depressants, such as alcohol or benzodiazepines, creating a synergistic effect that can quickly lead to death.
Beyond the acute overdose risk, prolonged use of Lean carries severe chronic health dangers, primarily revolving around the development of an Opioid Use Disorder (OUD). Codeine is addictive, and chronic consumption leads to physical dependence, requiring increasing amounts to achieve the same effect. Severe withdrawal symptoms reinforce the cycle of addiction.
The mixture’s high sugar content, combined with the dry mouth effect caused by promethazine’s anticholinergic properties, creates an environment for severe and rapid dental decay, often called “syrup teeth.” Long-term abuse also places stress on internal organs. Chronic opioid use can cause severe constipation and gastrointestinal issues. The continuous high dosage of active ingredients strains the liver and kidneys from processing massive amounts of the drug mixture, contributing to serious health complications.