Purple Drank (Lean) Abuse: Effects and Symptoms

Lean drink, also referred to as “sizzurp” and “purple drank,” is a prescription-strength cough syrup that contains the drugs codeine and promethazine.1 Lean is most often used in liquid form and is commonly mixed with sodas such as Sprite or hard candy to improve the flavor.1

The mixture of prescription cough syrup and soda often creates a purple concoction, which is why people may refer to lean by names such as “purple drank.”7 As a recreational drug, lean first became popular in the United States back in the 1990’s,1 initially made popular by rappers and pop stars.7 More recently, lean has become popular among adolescents throughout the United States, especially in concert settings, as it may be used among those who want to get high or drunk without having to purchase alcohol or illicit drugs.7

Why Do People Abuse Lean?

The intoxicating mix of lean is very popular in the United States, with an estimated one in ten teenagers abusing codeine cough syrup to get high in 2014.7 But why is it so popular?

The active drugs in purple drank are a combination of codeine and promethazine. Codeine is an opioid medication prescribed to treat mild pain and act as a cough suppressant when you have cold or flu-like symptoms.7 Promethazine is a type of antihistamine medication that works to relax and sedate the body, and offer relief from congestion.1,7 Both of these drugs are often found in prescription cold or cough medicine.

In addition to medical use, prescription cold medication is used recreationally, although advised against by health professionals. Since codeine creates feelings of relaxation and euphoria when ingested1 drinking prescription cold medication alone or mixed with alcohol is often sought after for the “high” it provides.7

Risks of Purple Drank Abuse

Lean drink is a very dangerous drug for a few reasons. First, there is no set standard for lean drug potency, and thus the soda to cough syrup ratio may differ depending on who makes the drug.11 This greatly increases the risk of overdosing on lean.

Second, lean can cause your breathing and heart rate to slow down significantly.1 Since purple drank is often mixed with other drugs such as alcohol, it can be very physically risky for those who drink it.1 Many celebrities have ended up dead or hospitalized due to lean consumption.7

Addiction to Purple Drank and Other Drugs

Codeine, the active drug in lean drink, is a type of opioid, a medication class that includes the illicit drug heroin in addition to other prescription medications such as oxycodone and fentanyl.5 Opioids affect the brain and spinal cord5 by reducing the intensity of pain perception in the body, and affect the brain to create feelings of euphoria or a sense of “high.”5

People often seek out opioid drugs such as lean due to the pain relief and feelings of pleasure they provide. However, when the brain is stimulated by opioids, a chemical known as dopamine is released in the brain. Normally, dopamine helps to reinforce pleasurable activities in our daily lives, such as exercise,12 and essentially tells our brain to continue behaving in the same way. As a result, when you take opioid medications, the brain is stimulated to want more and more of the drug, leading to addiction.12

Drug Tolerance

As you continue to take lean, drug tolerance—when your body needs more of the drug to have the same effect—may develop. As drug tolerance begins to develop, you will find that you are physically dependent on the drug which means when you try to cut back or quit taking the drug you’ll experience withdrawal, which can be extremely dangerous.

To help curb withdrawal symptoms, people may begin taking the drug again to help relieve their discomfort. This leads to the vicious cycle we often see with opioid use and is what makes opioid drugs such as lean so addictive.5

Risks of Mixing Lean with Alcohol

Lean is commonly mixed with alcohol1 and the two—alcohol and opioids—are the most addictive drugs in the United States when used separately.7 As a result, mixing alcohol and opioids can quickly lead to dependence, addiction, and serious health consequences.7 However, no matter how lean is ingested, the pleasurable effects provided by the active drug codeine can quickly lead people to become addicted to lean.2

Side Effects of Lean Use and Abuse

Lean can have many effects on the body. A few examples of what a person may experience while on lean include:1,5

  • Feelings of relaxation
  • Euphoria (feelings of intense happiness or excitement)
  • Sleepiness
  • Confusion
  • Dizziness
  • Slower breathing rate
  • Nausea
  • Sweating
  • Constipation
  • Dry mouth

Signs and Symptoms of Purple Drank Abuse and Addiction

The first sign that you may be addicted to lean is your tolerance to the drug. Lean tolerance indicates that you are highly at risk of or already are physically and/or psychologically dependent on it.8 The length of time it takes someone to become physically dependent on or addicted to lean varies on the person.8

There are a few things to look for if you suspect someone you know or you yourself may be misusing or addicted to opioid drugs such as lean. Behavioral changes include:5

  • A change in the friend group
  • Carelessness with grooming and self-care (such as no longer getting haircuts)
  • Worse grades in school or declining job performance
  • Loss of interest in activities that were once enjoyed
  • Changes in eating patterns
  • Changes in sleeping habits
  • Deteriorating relationships with family and friends

Withdrawal Symptoms

Initially, you may realize you have developed a physical dependence on lean if you experience symptoms of withdrawal when you go long periods without using the drug. Early symptoms of withdrawal from opioids such as codeine, the active drug in lean, include:8

  • Anxiety
  • Agitation
  • Muscle aches
  • Difficulty falling asleep or staying asleep
  • Runny nose
  • Sweating
  • Yawning
  • Teary eyes
  • Muscle aches

As more time goes on, different symptoms may appear. Symptoms of withdrawal from lean that may appear later include:8

  • Diarrhea
  • Abdominal cramping
  • Dilated pupils
  • Nausea
  • Vomiting
  • Goosebumps

Why Lean is Popular

Lean or purple drank has become popular among teenagers, as it offers a “high” without having to obtain alcohol or other illicit drugs.7 The fame brought to lean by pop stars and hip hop artists has resulted in increased lean use throughout the United States since the 1990’s.7

The codeine in lean creates a sense of euphoria and relaxation and is particularly intoxicating when mixed with alcohol.1 The social popularity of lean in addition to its effects on the body are what have contributed to the high rate of lean abuse in recent decades.

The reasons why one person may be more at risk of becoming addicted to lean than others is complex. Addiction results from a combination of environmental, genetic, and lifestyle factors. In addition, certain factors increase a person’s likelihood of becoming addicted to recreational drugs. These include things such as a history of depression or other psychiatric disorders, a history of substance use, a history of childhood abuse, and certain personality traits such as impulsivity.13

It is a combination of social, health, economic, and lifestyle factors combined with genetic makeup that may determine a person’s individual risk of becoming addicted to opioids.

Purple Drank: A Gateway Drug

Use of lean or purple drank often involves a combination of opioid and alcohol use. Used on their own, both alcohol and opioids are two of the most addictive substances available in the United States.7 As a result, the casual use of lean has the potential to lead to alcohol abuse and addiction. In addition, those who abuse lean are at a higher risk of becoming addicted to other drugs such as morphine and heroin.14

Treatment for Lean Drink Addiction and Abuse

If you’re physically dependent on lean you may find that after long periods of not taking the drug, you begin to experience symptoms of withdrawal. Although generally not life-threatening, withdrawal symptoms are uncomfortable and at times painful. If you’re quitting lean use, you should seek help from a health professional. Call 800-681-1058 (Info iconWho Answers?) to speak to a treatment specialist today.

Treatment for lean abuse may look similar to the following:8

  • The healthcare provider will complete a physical examination and ask questions about medical history and history of drug use.
  • The healthcare provider might collect blood or urine tests to screen for drugs and confirm opiate use.
  • Other tests may be conducted, depending on the provider’s concerns. These include:
    • Liver function tests
    • CBC blood tests to get an understanding of a person’s overall blood count
    • A chest x-ray to screen for illnesses commonly seen among those who use opioids, such as tuberculosis (TB)

You may go through withdrawal in a number of settings, including at home, at a detoxification center, or in a hospital, depending on the severity of your symptoms and whether or not you have a support person who can help them navigate detoxification in the home setting.

Recovery from Purple Drank

Once you have successfully gone through withdrawal from purple drank, you can begin the process of receiving treatment for opiate addiction. Treatment for those addicted to opioids often involves a combination of medication, counseling, and other support.8

If you or someone you know is struggling with lean addiction, call 800-681-1058 (Info iconWho Answers?) and speak openly and honestly about your treatment goals with an addiction specialist, and then work with them to create a treatment plan that works for you.

Medications are often used in the treatment of opiate addiction which may include:8

  • Medications to help treat the symptoms of detoxification. These may include medications for nausea and diarrhea, muscle aches, or other symptoms.
  • Methadone. This medication helps relieve withdrawal symptoms or may be used as a long-term maintenance medication for those with a history of opioid dependence.
  • Buprenorphine. This medication also helps to treat withdrawal and can shorten the length of the detoxification process. Similar to methadone, this medication may also be used for long-term maintenance therapy to help reduce the risk of relapse.
  • Naltrexone. This medication may be used to help prevent a person from relapsing. It is available as a pill or as an injection.
  • For individuals who have struggled with opioid withdrawal multiple times in their lifetime, research supports long-term medication treatment with either methadone or buprenorphine.

After going through withdrawal and detoxification, you may also need counseling to remain drug-free.8 There are many treatment options available, such as:

  • Self -help groups, such as Narcotics Anonymous
  • Outpatient therapy specifically designed for those recovering from drug addiction
  • Intensive outpatient treatment, such as a day program at a local hospital

If you or someone you know is struggling from lean addiction, don’t wait. Help is available. Call 800-681-1058 (Info iconWho Answers?) to discuss treatment options today.


    1. National Institute on Drug Abuse. (2015, May). Syrup,” “Purple Drank,” “Sizzurp,” “Lean”.
    2. National Institute on Drug Abuse. (2017, December 17). Over-the-Counter Medicines DrugFacts. Retrieved 2020, December 8.
    3. National Institute on Drug Abuse. (2020, August 3). What Is Lean?. Retrieved 2020, December 8.
    4. National Institute on Drug Abuse. (2020, August 3). Does Your Family Know the Risks of Misusing Opioids? Retrieved 2020, December 8.
    5. Substance Abuse and Mental Health Services Administration. (2019). Tips for Teens. Opioids: The Truth About Opioids.
    6. American Addictions Center. (2020). Cough Syrup with Codeine Abuse, Also Known as Lean and Purple Drank.
    7. U.S. National Library of Medicine. (2020, May). Opiate and opioid withdrawal.
    8. National Institute on Drug Abuse. (2020, August). Commonly Used Drugs Charts.
    9. Substance Abuse and Mental Health Services Administration. (2013). Opioid Overdose Prevention Toolkit.
    10. Ashley Addiction Treatment. (2017, June). What is Lean? Learn the Facts.
    11. American Addictions Center. (2020, July). Opiate Withdrawal Timeline, Symptoms, and Treatment.
    12. U.S. National Library of Medicine. (2017, November). Opioid addiction.
    13. National Institute on Drug Abuse. (2020, April). Common Comorbidities with Substance Use Disorders Research Report: Part 2: Co-occurring Substance Use Disorder and Physical Comorbidities.
Audrey Morrison MS Nursing
Audrey Morrison, MSN, DNP, PMHNP-BC
Psychiatric Nurse Practitioner, Author
Psychiatric Mental Health Nurse Practitioner Fellow who gained experience in providing comprehensive and holistic mental health treatment for patients across the lifespan at a federally-qualified community health center (FQHC). Received additional preceptorship and didactic training in providing high-quality psychiatric care in the community setting.