“Lean,” also known as “purple drank” or “sizzurp,” is a dangerous, illicit, recreational drug mixture containing prescription codeine and promethazine cough syrup mixed with soda (typically Sprite or Mountain Dew) and hard candy (usually Jolly Ranchers) for sweetness and color. Some people who want to feel stronger effects mix the drink with alcohol. Despite its candy-like appearance and sweet taste, lean is an extremely dangerous substance that has caused many overdose deaths [1].
The risks of lean include respiratory depression (shallow breathing that leads to a buildup of carbon dioxide and a lack of oxygen) that can lead to brain damage or death, physical dependence that develops with regular use and leads to painful withdrawal, and significantly escalated danger when mixed with alcohol, other opioids, or benzodiazepines [2]. Additionally, certain individuals metabolize codeine unusually rapidly, making even standard doses potentially fatal, especially in children and adolescents.
Understanding what lean does requires knowing how its two main ingredients affect your body. When you consume codeine, your liver converts it into morphine. This morphine then binds to opioid receptors [3] throughout your brain and body, particularly in areas that control pain, pleasure, and breathing. This binding produces pain relief, euphoria, and a sense of relaxation. However, it also slows your breathing rate, which becomes dangerous at higher doses. With repeated use, your brain adapts to codeine’s presence, requiring more to achieve the same effects (tolerance) and causing withdrawal symptoms when you stop (dependence).
Promethazine is an antihistamine and phenothiazine medication that was designed to treat allergies and nausea, but it also causes significant sedation. More importantly, promethazine further depresses the central nervous system and breathing. When combined with codeine, it intensifies the opioid’s sedating and respiratory-depressing effects, making the mixture hazardous. The FDA has issued specific warnings [4] about this combination, especially for children and adolescents.
Does lean get you high? Yes, and within minutes to hours of consuming lean, users experience various physical and psychological effects. The desired effects that users seek include feelings of relaxation and calm, detachment from worries or stress, pleasant drowsiness and sedation, euphoria or a “high” feeling, and slowed perception of time. These effects typically last four to six hours, depending on the dose.
However, what lean does to you includes numerous dangerous physical effects: excessive drowsiness and extreme sleepiness, dizziness and impaired balance, slowed reaction time and coordination, blurred vision and difficulty focusing, nausea and vomiting despite promethazine’s anti-nausea effect, constipation, slowed breathing rate (respiratory depression), decreased heart rate, and lowered blood pressure.
Lean also significantly impairs thinking and behavior, causing impaired judgment and decision-making, confusion and difficulty concentrating, slurred speech, impaired memory formation, where users may not remember what happened while high, and increased risk-taking behaviors. The greatest danger lies in the fact that the sedation can progress to unconsciousness, and the respiratory depression can become severe enough to cause death. Users may “nod off” or appear to fall asleep, but are actually experiencing dangerous levels of nervous system depression.
Regular lean use, even over just a few weeks to months, can cause serious health consequences. Because codeine is an opioid, regular use leads to dependence and addiction. Your brain chemistry adapts to expect the drug, and stopping causes withdrawal symptoms. Many users develop opioid use disorder (addiction), characterized by compulsive use despite negative consequences, inability to control or stop use, and life revolving around obtaining and using lean.
Prolonged lean use strains multiple body systems. The liver must process large amounts of codeine and promethazine, potentially causing liver damage. The kidneys face an increased workload from filtering these substances. The cardiovascular (heart and blood vessels) system experiences chronic suppression, potentially leading to heart problems.
The high sugar content in the soda and candy mixtures leads to severe tooth decay, cavities, and gum disease. Users often gain significant weight from the empty calories while potentially neglecting proper nutrition. “Lean gut” refers to gastrointestinal problems, including chronic constipation, a common side effect of opioids, and other digestive dysfunctions.
Chronic lean use causes persistent brain fog and difficulty thinking clearly, memory problems, difficulty forming new memories, mood disturbances, including depression and anxiety, and disrupted sleep patterns that persist even when not using. Some users experience psychotic symptoms, such as hallucinations (seeing, hearing, or feeling things that aren’t there), delusions (false, unshakable beliefs), and disordered thinking, speech, or severe mood swings. Repeated respiratory depression can cause long-term breathing problems and increased susceptibility to respiratory infections.
Opioid overdose occurs when the drug so profoundly depresses the breathing system that breathing becomes too slow and shallow to sustain life. Blood oxygen levels drop, carbon dioxide builds up, and without intervention, the brain suffers irreversible damage, or the person dies.
The risk of overdose skyrockets when lean is mixed with other central nervous system depressants. Alcohol and benzodiazepines like Xanax or Valium are particularly dangerous combinations [2]. These “stacked depressants” have synergistic effects, meaning their combined impact is even greater than just adding them together. This combination has caused numerous fatal overdoses, including among young people who underestimated the danger.
Learn to recognize the hallmark signs of opioid overdose: pinpoint pupils that are extremely small and don’t respond to light, blue or purple lips, fingernails, or skin indicating oxygen deprivation, slow, shallow, or stopped breathing, unresponsiveness or inability to wake the person, choking or gurgling sounds, and limp body or loss of muscle control [1]. If you observe any of these signs, this is a medical emergency requiring immediate action.
If you suspect someone has overdosed, call 911 immediately. State that someone is unresponsive and not breathing normally. Most states have Good Samaritan laws protecting people who call for help during overdoses from legal problems. Administer naloxone (Narcan) if available [5]. This medication rapidly reverses opioid overdoses by blocking opioid receptors. It comes as a nasal spray or injection. Give one dose, and if the person doesn’t respond within two to three minutes, give a second dose. Naloxone won’t harm someone if opioids aren’t involved.
Keep the person breathing. If they’re not breathing, begin rescue breathing or CPR if you’re trained. If they’re breathing but unconscious, place them on their side to prevent choking. Stay with them until help arrives and inform the emergency responders about what they took. This information helps medical personnel provide appropriate treatment.
Regular lean use, sometimes in as little as a few weeks, can lead to dependence on the codeine. When you stop using or reduce your intake, your body reacts with withdrawal symptoms.
Early withdrawal typically begins six to twelve hours after the last use and includes:
Peak withdrawal occurs one to three days after stopping. It brings
Later withdrawal symptoms from four to seven days and beyond show gradual improvement, but lingering effects of lean use may include:
The promethazine component may add additional sleep disturbances and mood issues during discontinuation.
While opioid withdrawal is uncomfortable, it’s rarely medically dangerous in otherwise healthy adults. However, attempting to stop suddenly without medical support often leads to relapse because the discomfort feels unbearable. Don’t try to stop using lean abruptly without medical guidance, especially if you’ve been using it regularly or in large amounts. Medical professionals can provide medications that significantly reduce withdrawal discomfort [6] and address co-occurring conditions like pain, anxiety, or depression.
If you’re struggling with lean use, recovery is possible with appropriate support. Discovery Institute of New Jersey provides comprehensive treatment for opioid dependence, including lean addiction.
We begin with a thorough medical and behavioral evaluation to understand your specific situation, including the extent of use, physical dependence level, co-occurring mental health or medical conditions, and personal goals for treatment. When indicated, we provide medically supervised detox that monitors vital signs, including breathing and heart function, manages withdrawal symptoms with appropriate medications, provides education about naloxone for overdose prevention, and provides safety and comfort during the difficult early days.
Based on your needs, we offer residential treatment for intensive care, intensive outpatient programs for flexible support while maintaining responsibilities, medication-assisted treatment when appropriate for opioid dependence, evidence-based therapies including cognitive behavioral therapy (CBT, a form of talk therapy that focuses on identifying and changing unhelpful thoughts and behaviors) and dialectical behavior therapy (DBT, a form of talk therapy that helps people manage intense emotions and behaviors) relapse prevention skill-building, and family support programs to help your loved ones understand and support your recovery.
Recovery extends beyond initial treatment. We provide connections to support groups, ongoing therapy options, help establish recovery-friendly routines and relationships, and strategies for maintaining sobriety long-term. Contact us for a confidential consultation to discuss your situation and explore how we can assist you.
Our compassionate counselors are standing by to answer any questions you may have. After helping thousands of people over the last 50 years, we have the resources to help you and your family and all your individual needs.
The Discovery Institute aims to provide accurate, ethical, clinically sound information regarding addiction and mental health for individuals and their families. All content published by The Discovery Institute is reviewed for accuracy and clarity by qualified individuals and is medically reviewed. We aim to make complicated subjects easy to understand without resorting to fear-based marketing techniques or misleading assurances. Content is regularly reviewed and updated to reflect current best practices, ensuring readers receive reliable, supportive guidance.
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