“Wock,” also known as “Lean,” “sizzurp,” or “purple drank,” is a recreational concoction made from prescription-strength cough syrup. This syrup contains the opioid codeine and the antihistamine promethazine, which is mixed with soda and often hard candy for flavor. Users consume large, non-therapeutic doses to achieve intoxication. This substance abuse carries a high risk of addiction, severe health complications, and fatal overdose due to the powerful central nervous system-depressant effects of its active ingredients.
How Codeine and Promethazine Affect the Body
The effects of Wock are driven by codeine and promethazine. Codeine is an opioid prodrug and central nervous system depressant. Its effects begin after the liver enzyme CYP2D6 converts it into morphine. This morphine binds to mu-opioid receptors in the brain and spinal cord, reducing pain signals and producing euphoria and deep relaxation.
Promethazine is a first-generation antihistamine with strong sedative properties that also acts as a central nervous system depressant. When combined with codeine, promethazine enhances the overall depressant effects, intensifying the “high” and contributing to drowsiness and lethargy. The combination results in severely impaired motor skills, slowed reaction time, detachment, and the heavy-lidded state often called “nodding.”
Acute Dangers and Overdose Risk
The most significant immediate danger of using Wock is acute overdose, typically caused by severe respiratory depression. Since both codeine and promethazine suppress the body’s natural drive to breathe, breathing can become dangerously shallow or stop entirely. This risk is dramatically increased because users consume massive amounts of the syrup, far exceeding any safe therapeutic dose.
The danger is compounded when Wock is mixed with other central nervous system depressants, such as alcohol or benzodiazepines. This polydrug use creates a synergistic effect, rapidly increasing the chance of respiratory failure. Signs of an acute opioid overdose include extremely slow or shallow breathing, cold and clammy skin, constricted pupils, and unresponsiveness. Immediate emergency medical attention is necessary, and the opioid effects of codeine can be temporarily reversed with the medication naloxone (Narcan).
Developing Dependency and Long-Term Health Consequences
Repeated use of Wock quickly leads to physical tolerance, requiring ever-increasing amounts to achieve the same euphoric effect. This escalation leads toward developing physical dependence and, ultimately, an opioid use disorder. The chronic presence of codeine chemically alters the brain’s reward system, making it difficult for a person to feel normal or experience pleasure without the drug.
The physical consequences of long-term use are severe. Opioid use commonly causes chronic, severe constipation and can also lead to urinary retention. Because the mixture is often prepared with sugary sodas and hard candies, regular consumption can lead to rapid and extensive dental decay, often referred to as “lean mouth.”
The liver and kidneys also face strain as they work to process the excessive amounts of codeine and promethazine. When a person dependent on Wock stops using, they experience withdrawal symptoms, which are intensely uncomfortable and include severe cravings, nausea, vomiting, muscle aches, insomnia, and profound anxiety.
Accessing Treatment and Recovery Resources
Overcoming dependence on Wock requires professional intervention and support, beginning with a medically supervised detoxification program. Detox programs manage withdrawal symptoms in a safe environment and are the first step toward recovery. Medication-assisted treatment (MAT) is often used for opioid use disorder, utilizing medications such as buprenorphine or methadone to help reduce cravings and prevent relapse.
Behavioral therapies, including individual counseling and group support, are also foundational components of a comprehensive treatment plan. Resources are available through national helplines and local treatment centers if you or someone you know is struggling with substance abuse related to Wock. Contacting a healthcare provider or a dedicated substance abuse treatment service can provide the guidance needed to begin the path to recovery.