Lean is a recreational drug made by mixing prescription cough syrup containing codeine and promethazine with soda and sometimes candy. The codeine is an opioid, and the promethazine is a sedating antihistamine. Together they produce a slow, drowsy high that carries serious risks, including fatal respiratory depression. The drink goes by several street names: purple drank, sizzurp, and dirty Sprite.
What’s Actually in It
The base ingredient is a prescription cough syrup that combines codeine phosphate and promethazine hydrochloride. Codeine is a narcotic pain reliever and cough suppressant. Promethazine blocks histamine receptors, which produces strong sedation and helps prevent nausea. Users pour the syrup into a large cup of soda (Sprite and Mountain Dew are common choices), then often drop in hard candy like Jolly Ranchers for extra sweetness and color. The result is an intensely sweet, often purple-tinted drink that masks the medicinal taste of the syrup.
The exact ratio varies from person to person, which is part of what makes lean unpredictable. Some people pour a few ounces of syrup per cup; others use far more. Because there’s no standardized “dose,” the risk of taking too much is built into the way the drug is used.
How It Affects the Body
Codeine works on the central nervous system to relieve pain and suppress coughing. At recreational doses, it produces euphoria, relaxation, and a feeling of slowed-down time. Promethazine amplifies those effects. According to the FDA’s own drug label, promethazine is “additive to the depressant effects of codeine,” meaning the two ingredients don’t just coexist in the body. They stack on top of each other, deepening sedation beyond what either drug would cause alone.
That additive quality is exactly what users seek and exactly what makes lean dangerous. Both drugs slow down the central nervous system. Together, they can slow breathing to a dangerous degree, a condition called respiratory depression. Breathing becomes shallow and irregular, reducing the amount of oxygen reaching the brain and other organs. In severe cases, breathing stops entirely.
Short-Term Side Effects
Even a single use can produce a range of unwanted effects. Common ones include extreme drowsiness, blurred vision, nausea, dizziness, and constipation. Because promethazine is a powerful sedative on its own, users often feel heavily impaired, with slowed reaction times and difficulty concentrating. Higher doses can cause confusion, hallucinations, and loss of motor control.
The risk jumps dramatically when lean is combined with alcohol, benzodiazepines, or other drugs that depress the central nervous system. The CDC warns that drinking alcohol while using opioids “can make it hard to breathe, which can damage your brain and other organs.” This combination is a leading cause of overdose deaths, and lean users frequently drink alcohol alongside it.
Long-Term Health Damage
Chronic use of lean can cause lasting harm to multiple organ systems. Repeated oxygen deprivation from episodes of respiratory depression damages the brain, heart, liver, and kidneys over time. Liver and kidney damage are well-documented consequences of long-term codeine and promethazine misuse, particularly when alcohol is also involved.
Codeine also slows the digestive system significantly. Long-term users frequently develop severe, chronic constipation that can progress to bowel obstruction. Weight gain is common due to the enormous sugar content of the drink itself, since each cup combines sugary soda with syrup and candy. Dental problems follow for the same reason.
Addiction and Withdrawal
Codeine is an opioid, and regular use leads to physical dependence. The body adapts to the drug’s presence, requiring larger doses to achieve the same effect (tolerance) and producing withdrawal symptoms when use stops. Lean is sometimes perceived as a “soft” drug because it’s based on cough syrup rather than pills or injections, but the addiction pathway is the same as with any other opioid.
Withdrawal symptoms include anxiety, insomnia, sweating, nausea, diarrhea, body aches, agitation, runny nose, teary eyes, loss of appetite, and intense cravings. These symptoms are physically uncomfortable and can be severe enough to drive relapse without support. Medical detox programs sometimes use medications to shorten the withdrawal period and manage symptoms.
Legal Status
Codeine-promethazine cough syrup is a controlled substance under federal law. The DEA classifies cough preparations containing limited amounts of codeine (no more than 200 milligrams per 100 milliliters) as Schedule V, the least restrictive controlled substance category. That includes brand-name products like Phenergan with Codeine. Higher-concentration codeine products fall under stricter schedules. Regardless of the schedule, obtaining or possessing these syrups without a valid prescription is illegal.
Despite its legal restrictions, lean remains widely available through diverted prescriptions, online marketplaces, and social sharing. Its prominent presence in hip-hop music and social media has normalized its use in some communities, particularly among young adults and teenagers. That cultural visibility can obscure the reality that lean delivers an opioid to the brain in a way that is genuinely addictive and, in the wrong circumstances, lethal.