purple lean in styrofoam cupShare on Pinterest
Illustration by Brittany England

Lean, also known as purple drank, sizzurp, barre, and Texas tea, among other names, is a concoction of cough syrup, soda, hard candy, and, in some cases, alcohol. Originating in Houston, Texas, it’s typically served in a white Styrofoam cup.

The term “lean” comes from the position it tends to put you in after drinking it.

Here’s a look at what’s going on behind the Styrofoam.

People have been misusing codeine, a main ingredient in lean, for ages, but lean’s prominence in pop culture has made it more popular than ever.

Rappers (and Justin Bieber) have been singing its praises in songs — and dying or having seizures from it — since the late ’90s (though it seems to have first appeared in the ’70s or ’80s).

Here’s a highlight reel of lean’s more specific claims to fame in pop culture:

  • Reports suggest it’s a major factor in Lil Wayne’s ongoing hospitalizations for seizures.
  • Bow Wow recently opened up about almost dying as a result of his addiction to lean.
  • The late Mac Miller also described dealing with an addiction to lean in 2013.
  • Rapper 2 Chainz was arrested at an airport for possessing promethazine, a key lean ingredient.

Then there are the high-profile athletes whose lean-related suspensions and hospitalizations continue to make the headlines.

The most commonly used ingredients are prescription cough syrup that contains the opioid codeine and the antihistamine promethazine.

The cough syrup is mixed with soda and sometimes alcohol. Some people also add hard candies, especially Jolly Ranchers, to the mix.

Others use over-the-counter (OTC) cough syrup containing dextromethorphan (DXM) instead. Since OTC cough syrups no longer contain alcohol, people usually add their own alcohol to the OTC version of lean.

Other variations of purple drank involve a combination of codeine tablets added to cough syrup and soda.

The amount of each ingredient varies. But to get the desired effects, a lot more than the recommended or safe dose is used.

Yes and no.

The Drug Enforcement Administration classifies codeine as a Schedule II controlled substance when it’s a single ingredient. It remains a lesser, but still potent, controlled substance when mixed with other ingredients.

All products containing it are only available with a prescription due to the risk of misuse. The distribution or manufacturing of it without a license is illegal.

Cough syrups containing codeine fall into the risk of misuse category since Actavis — considered to be the best of codeine cough syrups by lean users — was taken off the market due to its popularized misuse.

DXM cough syrup is available without a prescription, but some states restrict the sale of it to people over the age of 18.

Lean creates a feeling of euphoria and relaxation that makes you feel dreamy, almost like you’re floating away from your body. It acts on your central nervous system (CNS) and slows your brain activity for a sedating effect.

While some people may enjoy the euphoric effect of lean, it can also produce other less than desirable, and even downright dangerous, effects in high doses, including:

Combining alcohol enhances the effects of the codeine and DXM. While it may seem like a good way to get higher, it’s not a great idea.

Short-term effects of adding alcohol to lean include:

  • trouble breathing
  • drowsiness or sleepiness
  • delayed motor skills or reaction time
  • poor judgment
  • brain fog

Plus, your chances of overdosing are a lot higher when you combine alcohol with codeine or DXM.

The most serious potential effect of mixing even a small amount of alcohol with cough syrup is respiratory depression. This reduces the amount of oxygen to your brain. It can lead to organ damage, coma, or death.

Lean can also have harmful interactions with other drugs, including some OTC medications.

Lean can intensify and prolong the sedative effects of other CNS depressants, including:

Lean may also interact with herbal remedies and supplements, including natural sleep aids, such as valerian root and melatonin.

Like alcohol, all of these things can intensify the impact of lean on your CNS, resulting in potentially life-threatening side effects.

Quite a few, actually.

Liver damage

Acetaminophen, a common ingredient in cough and cold medications, has been linked to liver damage when you take more than the recommended dose or drink alcohol while taking it.

Remember, lean involves using way more than the recommended dose of cough syrup.

High amounts of acetaminophen and other drugs can prevent your liver from properly metabolizing chemicals, leading to excessive amounts in your liver. According to the Food and Drug Administration (FDA), prescription and OTC drugs are the leading cause of acute liver failure.

Signs of liver damage include:

On their own, codeine and alcohol can also cause liver damage when you ingest more than the recommended dosage.

Withdrawal symptoms

Purple drank contains ingredients that are habit-forming. This means you can quickly develop a tolerance and dependence to it. In a nutshell, you’ll need more of it to get the desired effects and feel lousy when you don’t drink it.

Common withdrawal symptoms include:

Other long-term effects

Lean can also cause a number of other long-term effects, including:

Very.

Just about every active ingredient used in every variation of lean can increase the amount of dopamine in your brain’s reward system and lead to addiction.

Unlike dependence, which involves your body simply getting used to a substance, addiction results in cravings and a complete loss of control over use.

Signs of a lean addiction include the following:

  • You need more of it to get high.
  • You can’t stop drinking it even though it’s negatively affecting your life, like hurting your relationships, schoolwork, job, or finances.
  • You crave it and think about having it constantly.
  • You drink it as a way to cope with your feelings or stress.
  • You have withdrawal symptoms when you don’t drink it.

These withdrawal symptoms include:

Absolutely. There are many cases of people who’ve died from lean, either due to overdose or complications caused by long-term use. Some high-profile cases of this include the deaths of rappers DJ Screw, Big Moe, Pimp C, and Fredo Santana.

CNS depression from drinking high amounts of lean can slow or stop your heart and lungs. The risk of a fatal overdose is even higher when you mix it with alcohol.

Unlike some other drugs, there aren’t many ways to make using lean less risky. If you or someone you know are planning on using lean, you need to know what overdose signs and symptoms to watch for.

Overdose signs and symptoms

Call 911 right away if you or someone else experiences:

You may be scared to call for help if you’ve been taking an illegal substance, but early treatment could prevent permanent damage or even death.

Developing an addiction to lean is totally possible. Remember, one of its main ingredients, codeine, is an opioid. This is a type of drug with a high potential for dependence and addiction.

If you’re concerned about your drug use, there’s help available. You can bring it up to your healthcare provider if you feel comfortable. Keep in mind that patient confidentiality laws will prevent them from reporting this information to law enforcement.

You can reach out to one of the following free and confidential resources: