Drug and Alcohol - Opioid Addiction

What Is Lean, and Is Codeine Cough Syrup Addictive?

What is lean? Get the facts about codeine cough syrup

Drank, sizzrup, lean, and more: Codeine cough syrup addiction is dangerous. Learn more about this form of opioid abuse in our blog.

Written by

brian-mooreBrian Moore

Content Writer

Reviewed by

jeremy-arztJeremy Arzt

Chief Clinical Officer

Drug and Alcohol

Opioid Addiction

February 21, 2023

A popular drug of abuse among teenagers, lean is the name given to a combination of prescription drug codeine cough syrup and soft drinks. Teenagers or adolescents mostly abuse this substance because even though they are underage, they can access prescription-strength opioids in the form of cough syrups.

Often, people abusing codeine cough syrup also add some candies or gummy worms in their preparation of lean to give it a sweet and fruity flavor. 

Lean addiction in teens is a severe cause of concern in the USA because it contains codeine, a highly addictive opioid pain medication. It's surprisingly common; Justin Bieber is someone who has struggled with (and overcome) addiction to lean.

By the Numbers:

According to the National Center for Drug Abuse Statistics [NCDAS], youth drug abuse increased by 61 percent between 2016 and 2020. 

What Is Lean?

Codeine cough syrup is a prescription medication used to relieve complaints of the infections such as colds, influenza, allergies, rhinitis, and other respiratory ailments such as asthma or bronchitis. Decongestants aid in the relief of runny nose problems. This medicine also includes an opioid cough suppressor, which works on a particular part of the brain to reduce the desire to cough. Itchy throat, eyes, nasal airways, and sneezing are all relieved by the antihistamine promethazine.

What is Lean? This image defines lean and why people use lean (purple drank)

Kids under the age of 18 should refrain from taking narcotic cough suppressants. Children are more likely to experience severe (even deadly) harmful impacts, particularly respiratory issues. Talk about the dangers and advantages of this drug with your doctor. 

Even though it is a prescription-based opioid, there have been many instances where codeine has been frequently abused. Teenagers who are not eligible to buy liquor or alcohol are most frequently seen buying this without a prescription to mix it with soft drinks of their choice and try to experience a euphoric sensation.

Since addiction to lean is an indirect yet severe addiction to codeine, this blog will focus on the risks and hazards of consuming codeine-based cough syrups and their fatal side effects.

Is Lean a Drug?

Yes. While promethazine isn't a narcotic, codeine certainly is. Codeine may not be one of the more powerful opioid drugs, but it's still a narcotic and it's easy to develop a dependence on the codeine in lean.

Plus, mixing lean with other drugs, including alcohol, can rapidly become fatal. Codeine can fatally slow breathing on its own, and drugs like alcohol just amplify its effects.

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What's the History of Lean Abuse?

Cough medicine abuse has a surprisingly long history. Heroin, one of the most infamous opioid drugs in history, was initially advertised as a cough medication back in the late 1800s. When dextromethorphan (DXM) was introduced in the late 1950s, it was seen as a safer form of cough suppressant.

However, DXM can be abused, and rock musicians first mixed DXM with beer during the 1960s as a recreational drug. In the 1990s, some people began mixing codeine with soft drinks and/or candy to create lean. The drug caught on and was popularized in southern rap scenes in Houston and New Orleans. By the early 2000s, lean was recognized as a party drug.

What Does Lean Taste Like?

Codeine cough syrup often tastes unpleasant; cough syrup tends to have a medicinal taste few enjoy. In general, lean tastes sugary because it's often mixed with soft drinks and/or candy.

Is There Sugar and Caffeine in Lean?

Lean is often mixed with soft drinks, so yes, there's a lot of sugar and caffeine in lean.

Is There Melatonin in Lean?

Some users add melatonin, an over-the-counter supplement, into lean. This may increase the sedative qualities of lean. Mixing anything into lean is highly risky; even over-the-counter supplements can interact in unknown ways with drugs like codeine.

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What Form Does Lean Come In?

Lean is always some form of drinkable syrup. It's consumed as a mixture of codeine cough syrup and a soft drink. Some people mix lean with alcohol, but that's dangerous. Codeine and alcohol combined can be lethal, and lead to overdoses.

How Do You Make Lean?

Lean isn't really manufactured. It just involves mixing cough syrup containing codeine and promethazine with soft drinks or candy to add a sugary taste to it. We're not going to advise you on how to mix lean; lean is a dangerous drug people should avoid.

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What Are Some Street Names for Lean?

Lean is also commonly known as purple drank, sizzurp, lean drink, and dirty sprite.

Why Purple Drank?

Many forms of codeine cough syrup use purple food coloring.

Do People Consider Lean a "Hard Drug"?

Codeine cough syrup is a prescription medication. However, codeine is an opioid and recreational opioids are widely considered "hard drugs," A hard drug is a substance widely considered to have greater health hazards, a higher possibility of abuse, and tend to be far more addictive than other drugs.

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Is Lean an Illegal Drug?

Yes and no. Codeine cough syrup is a legitimate medication, but it's also a controlled substance, meaning you have to have a prescription to legally obtain and use it.

How Does Lean Make You Feel When You Drink It?

One of the reasons people abuse opioids is they unfortunately feel good to use. Lean creates feelings of sedation, relaxation, and euphoria. Promethazine, while not a painkiller, can also make a person feel sleepy and relaxed.

So, people abuse lean largely as a party drug because it feels good. At first.

Over time, a person who engages in lean abuse will need greater amounts of lean to feel the same effects. This is called tolerance. Higher doses of lean do two things: first, they increase the chances of developing an addiction to opioids. Second, higher doses of lean mean a higher chance of an opioid overdose as well.

Can You Overdose on Lean?

Yes. Codeine, while a milder opioid, can still depress breathing to the point where a person suffocates. Chad Lamont "Pimp C" Butler, half of the southern rap combo Underground Kingz (UGK), died in part from consuming too much lean.

Is Lean Bad For You?

Used under a doctor's direction, lean can make bad coughs easier to bear. Abusing lean, on the other hand, is dangerous and potentially lethal. High doses of codeine will make you overdose. High doses of promethazine can damage your organs.

Lean and Mental Health

Lean is also damaging to a person's mental health. Codeine affects the way cells in the brain function, and long-term opioid abuse can cause changes in the brain's function. Emotions, memories, and moods are all affected by opioid abuse.

Do People Still Use Lean?

Yes, lean is still a popular recreational drug. Codeine cough syrup is also regularly prescribed.

Codeine Cough Syrup: Can I Become Addicted to Lean? 

Opioids, including codeine, have the ability to convince a person's brain and body that there is nothing more important than getting high. So, the answer is yes. It is quite easy for teenagers to develop an opioid addiction due to abusing codeine cough syrup.

What is Lean Addictive? This image describe 3 reasons why lean is addictive.

After abusing lean for a while, some people may notice that they require larger portions of codeine in their concoction to get the same euphoric feelings as before. This can cause dependency. Teenagers are often uninformed and oblivious that addiction is a disease that can destroy their lives.

While some young adults can experience a high once or twice and return to everyday life without craving more syrup, many kids have a different experience. They get into the habit of drinking lean whenever they are at a party or even when feeling low. In a short period of time, they get dependent on the cough syrup and crave it all the time. 

What Are Some Signs of Lean Addiction?

Drug cravings are a sign of the development of addiction to codeine cough syrup. They make a person do wrong and immoral things even when they are well aware of the consequences. Teens show the following signs when they are on the verge of developing an addiction to lean:

  • They start isolating themselves

  • They lose interest in their hobbies or other activities they used to enjoy

  • They lose their appetite 

  • They start getting tired and exhausted 

  • They experience mood swings 

  • They feel irritable, anxious, and sad simultaneously 

  • Their sleep cycles are ruined 

These signs often progress to loneliness, spending time away from loved ones, seeking other drugs, etc. Often, these changes go unnoticed by family members and friends of the user until it's too late. People may not realize that their child, sibling, friend, or classmate is being sucked into the abyss of addiction. 

When a person has started abusing lean, it gets tough for them to stop. Withdrawal symptoms prevent teenagers from stopping this opioid abuse. The physical repercussions of abusing an opioid like codeine are purely painful. It even deteriorates your mental well-being. Numerous people report experiencing severe paranoia and unwanted anxious feelings after getting high from lean. Fear of having to go through such extreme agony and discomfort can often force people to keep loading up on lean. 

Codeine Cough Syrup: What Are the Side Effects of Drinking Lean?

Consuming lean regularly can lead to harmful and sometimes life-threatening consequences. You must call a doctor or take your child to a hospital if any of the following signs persist: 

  • Migraine

  • Brain fog/confusing thoughts

  • Nausea

  • Abdominal pain

  • Digestive issues 

  • Inability to urinate

what are the side effects of lean? This images displays 4 side effects of lean (purple drank)

Long-Term Lean Abuse Effects

Continued use of codeine in lean can lead to dangerous medical conditions. People who abuse codeine can experience the following issues:

  • Convulsions

  • Damaged vision

  • Delusions

  • High Blood Pressure

  • Seizures/tremors

  • Weight gain

  • Dental issues 

  • Disorientation

  • UTIs

If you or a loved one experiences any other odd side effects of lean, reach out to an adult. Immediately seek assistance if the person is not breathing or is unconscious. Dial 911 and request an ambulance. If the person is still conscious, contact a doctor immediately or proceed to the hospital for emergency treatment or drug detox

Additional Dangers of Codeine Cough Syrup: Promethazine

Promethazine is a prescription antihistamine usually found in codeine cough syrup. It relieves symptoms of hay fever and other allergic reactions. This medication works by blocking the effects of histamine, a chemical compound released by the immune system which blocks allergens. While histamines are very useful, many people experience an overreaction to common substances like pollen and dust, which is why antihistamines are useful in controlling allergic reactions.

Risks and Dangers of Lean. This image displays the risk of promethazine and codeine.

There are dangers to taking promethazine in large amounts, which is common during codeine cough syrup abuse. In large doses, promethazine can cause a person to become dizzy, drowsy, and have problems with their blood sugar. Promethazine also increases the effects of alcohol and other depressant drugs – like codeine.

Finally, large doses of promethazine can also have side effects very similar to large doses of opioids like codeine, including respiratory depression. Rapper Chad Lamont “Pimp C” Barker, one-half of the hip-hop duo Underground Kingz, died from an overdose of codeine cough syrup. It’s another reason why codeine cough syrup abuse is so dangerous.


Dextromethorphan, or DXM, is another ingredient found in some forms of codeine cough syrup. DXM is an over-the-counter medication found in many cough syrups, including NyQuil and Robitussin.

DXM abuse is a common form of drug abuse, especially among teens. DXM abuse has health risks of its own, too.

Opioid addiction can be lethal. Learn more about codeine cough syrup addiction in our blog.

Codeine Cough Syrup Withdrawal Symptoms

When consuming lean, youngsters are very likely to get addicted to the euphoric effects of codeine or other prescription-based cough medications. In addition, individuals addicted to lean have a high probability of experiencing unpleasant symptoms after quitting the drug. Such severe withdrawal symptoms are due to the alterations in the nervous system and the brain, which have adapted their functioning with the usage of this medicine.

Lean Withdrawal Symptoms. This image showcases all of the withdrawal symptoms of lean.

Without this drug, these vital organs will be unable to work properly. The most common withdrawal symptoms of lean are: 

  • Indigestion

  • Suppressed hunger 

  • Sore muscles

  • Weight loss

  • Nausea

  • Vomiting 

  • Blurred vision

  • Disturbed sleep cycle 

  • Stomach aches 

  • Intense headaches 

  • Muscle cramps 

  • Stuffed/runny nose and eyes

These withdrawal symptoms are severe for long-term, frequent lean users and may require emergency detoxification. When a dependency on codeine is detected, it is advised to see a physician before attempting to quit. Although opiate discontinuation is not usually harmful, it can induce diarrhea and might be uncomfortable to endure without professional assistance. In addition, the breakdown is highly hazardous since many people do not realize that even a brief hiatus from a narcotic can cause sensitivity loss, and restarting at the same amount as before to stop might end in lethal ingestion.

Codeine Withdrawal: A Timeline

Codeine is addictive. Like other addictive substances, a person who has been using codeine for a long time will experience withdrawal symptoms when they stop using it. Opioid withdrawal symptoms are infamously harsh and can be so unpleasant they drive a person back to codeine abuse.

Withdrawal from codeine should always be done with professional assistance at a drug rehab or drug detox center. At these facilities, a person detoxing from codeine abuse will be kept as safe and comfortable as possible. Recovery from codeine cough syrup addiction isn’t easy, but with the right help, it’s possible.

Timeline of Codeine Cough Syrup Withdrawal

Drug withdrawal timelines are tricky. There’s no set-in-stone time length; many factors drive a person’s experience when they detox from drugs like codeine cough syrup. Personal physiology, history of drug use, the amount of codeine cough syrup taken … everything affects how long codeine cough syrup withdrawal lasts.

That said, most people will experience the timeline listed below. Remember, detoxing from codeine cough syrup is always safer, easier, and more comfortable when done with professional help.

Phase 1: The First Two Days

The first two days of codeine cough syrup withdrawal tend to be the toughest. In general, withdrawal starts after 12 to 24 hours after codeine cough syrup was last used. The symptoms experienced during this phase of withdrawal are similar to the symptoms listed above. Also, drug cravings tend to be very high during this time.

Phase 2: The First Week

Withdrawal effects from codeine cough syrup tend to peak during the first week of codeine cough syrup withdrawal. For mild cases of codeine cough syrup, the symptoms also tend to decrease toward the end of the first week. Other symptoms experienced during the first week of withdrawal include:

  • Sleeping problems

  • Loss of appetite

  • Lethargy

  • Headaches

  • Shakiness

Phase 3: Two Weeks

By or close to the end of the first week, most people will feel their codeine cough syrup withdrawal symptoms fade. Heavier users may experience lingering side effects. In some cases, post-acute withdrawal syndrome (PAWS) may cause codeine withdrawal effects to last far longer.

This is why continuing care at drug rehab is always recommended. As useful as drug detox is, it’s only the first step in treating codeine cough syrup addiction. Drug rehab continues the hard work of drug detox and helps people build a new, healthy, and happy life for themselves.

How to Manage Withdrawal Symptoms of Codeine Cough Syrup

Not every teenager who stops abusing lean will experience extreme withdrawal symptoms. However, individuals should seek medical attention if they are experiencing significant withdrawal effects or need extended therapy for a substance dependence disorder.

According to the National Library of Medicine, a clinical expert may recommend medicines to relieve acute withdrawal effects in specific circumstances.

Naloxone is often used to treat the potentially fatal consequences of lean overdose. It relieves hazardous effects produced by elevated concentrations of opioids in the bloodstream by inhibiting the actions of opioids.

Suboxone (Subutex), a synthetic opiate agonist, is another drug that can help treat lean withdrawal symptoms. These medications activate the same opioid receptors as codeine, albeit to a reduced amount. Consequently, such medications help alleviate opiate side effects without raising a user's reliance on narcotics. Although suboxone represents a crucial instrument in treating lean addiction, the Food and Drug Administration (FDA) previously warned that oral dosing might induce gum disease, even in persons without a background of oral diseases.

As stated by National Institute on Drug Abuse (NIDA), a physician might advise Dolophine or methadone, an opiate analgesic, in extreme instances of drug addiction and abstinence. Methadone activates pain receptors more than POAs, making it especially useful in tapering people off codeine and other narcotics. Nevertheless, methadone can result in addiction. As a result, a user must seek medical advice about the dangers and advantages of consuming methadone to relieve codeine discontinuation effects.

What Happens During an Overdose of Codeine Cough Syrup?

If someone is exhibiting the following symptoms, it is a big possibility that they may be experiencing an opioid overdose:

  • Lack of response or drowsiness 

  • Bubbling or snoring noises

  • Red, motionless eyes

  • Erratic or slow breathing 

  • Clammy or icy hands and skin

  • Discolored nails and lips 

In the event of an overdose, dial 1-800-222-1222 for poison control. If the person has fainted, had a stroke, has respiratory distress, or cannot be revived, dial 911 instantly. 

Even though codeine is a weak narcotic compared to others, overdosing is very possible and may prove fatal. Opioids suppress the nerve cells, which regulate vital activities such as pulse and respiration. A codeine excess can induce respiration to slow to deadly rates, restricting the amount of oxygenation reaching the brain. When this occurs, fast cell death occurs, and the infected individual may experience unconsciousness, head trauma, or even death.

Lean addiction in teens can also be treated using drugs inhibiting synapses in the brain's reward center. Still, treatment must be administered quickly enough to minimize neurological damage from respiratory failure. In addition, it carries a serious danger of liver failure if the drug is taken with other medicines, such as paracetamol, which is frequent when individuals strive to overcome a terrible illness (and even opiate side effects).

When paracetamol is dissolved, it generates a chemical that is especially difficult on the liver. When the liver is also having to process a significant amount of an opioid, it can potentially cause strain and lead to chronic liver failure. Treatment alternatives should be considered at this stage.

Does Lean Have Psychological Effects?

Yes. Lean, like other opioids, affects the brain’s functions and changes the chemicals which help the brain communicate with the body. Codeine over time changes the way a person expresses and interprets emotions, causing changes in how they act and think.

Lean creates intense feelings of euphoria and sedation, but when a person stops using it, they often feel the withdrawal effects of lean mentioned above. Plus, all opioids are known to have adverse effects on a person’s emotions and mental outlook.

Does Lean Have Any Benefits?

Codeine is both a cough suppressant and a painkiller, and codeine can make coughing more bearable for someone already in pain from a chest infection or an injury. However, the effects of all cough medications have been debated as to whether or not they work, and the addictive nature and ease of abuse of lean make it a more dangerous cough medication for many.

Who Gets Addicted to Lean?

Drug abuse transcends class, race, nationality, and more. Anyone who abuses opioids will develop an addiction to them sooner or later. That said, most people who get addicted to lean tend to be younger.

Treatment for Codeine Cough Syrup Addiction

There are various recovery options available for individuals struggling with addiction to codeine cough syrup. Recovery from codeine addiction is a long and complex process that may require a combination of approaches. Here are some of the recovery options:

  • Medical Detox: Lean addiction treatment often starts with a medical evaluation. After conducting a thorough assessment, healthcare professionals generally conduct a medical detox. This helps teenagers eliminate the excess lean, aka codeine, from their bodies. Medical professionals prescribe some medications after detox if the patient exhibits withdrawal symptoms and side effects. 

  • Inpatient/Outpatient Rehabilitation Programs: Inpatient drug rehab or outpatient drug rehab programs provide a structured environment for teens with lean addiction to receive professional support and treatment. Poor addiction treatment programs in the inpatient setting involve living at a rehab facility and receiving round-the-clock care. In contrast, outpatient programs allow individuals to live at home and attend therapy and counseling sessions regularly.

  • Individual Therapy: Individual therapy is a one-on-one counseling session with a trained therapist or counselor. In individual therapy, individuals can explore the underlying reasons for their addiction to codeine, learn new coping skills, and develop a plan to manage triggers.

  • Group Therapy: Group therapy involves regular meetings with other individuals struggling with lean addiction. Group therapy provides a supportive environment for individuals to share their experiences, learn from others, and receive encouragement and support.

  • 12-Step Programs: 12-Step programs, such as Narcotics Anonymous (NA), provide a structured program for individuals to work through the recovery process. The 12-Step program involves working through the 12 steps with the support of a sponsor and attending regular meetings with other individuals in recovery.

Developing an addiction to codeine cough syrup is especially dangerous because the number of opioids people consume in cough syrups can prove fatal. Opioids are highly addictive, and consuming them regularly at a tender age can mess up things for youngsters. 

When anyone gets caught in the snare of opioid addiction, it affects everyone around them: their parents, friends, siblings, etc. It is like losing hope for the future. But the good news is recovery is possible if you can accept and address this issue at an early stage. Then, you can recover from codeine cough syrup addiction and go on to accomplish better things. 

Caught in the Grip of Codeine Cough Syrup Addiction? The Edge Treatment Center Will Help

Codeine cough syrup addiction can be very easy to fall into. Opioid addiction is one of the deadliest forms of addiction. Getting help is a crucial step to freeing yourself (or a loved one) from the grip of opioids.

The Edge Treatment Center provides expert help for codeine cough syrup addiction and more. Our outpatient drug rehab has helped many build new, healthy, and happy lives for themselves, leaving substance abuse behind permanently. First, we'll help you find a drug detox center. When you enter our care, The Edge will help you develop the resources and tools you need to live a life without codeine addiction.

If you want more information on codeine cough syrup addiction or more, contact The Edge Treatment Center today.

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