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The Dangers of Lean


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Medically Reviewed by Dr. Mohammed Saeed, MD.

What is Lean?

Lean is a homemade drug that is just as dangerous as heroin or cocaine. The name “lean” refers to the effects of the drug – it makes users drowsy and causes loss of balance, so they need to lean against something to keep from falling over. Lean is also called Purple Drank, sizzurp, purple tonic, sip-sip, syrup, and Dirty Sprite. No matter the name, it is an addictive substance that can be lethal if you overdose.

Lean’s effects include euphoria, dissociative (out of body) sensations, and relaxation, and last for 3 to 6 hours.

Lean’s origins can be traced back to Houston in the 1960s when musicians mixed Robitussin with beer to alter their state of mind and find inspiration. Sadly, lean has been popularized in the rap and hip-hop communities despite the fact that it may have contributed to the deaths of rappers DJ Screw, Big Mo, and Pimp C. It has put many others in the hospital, including Famous Dex and Lil Wayne. This public acceptance of lean is dangerous because each celebrity who endorses it can influence many people, especially young people in middle and high school.

Lean is made from a cough syrup that includes codeine, dextromethorphan, or promethazine, soda (usually Sprite, Mountain Dew, or 7-Up), and hard fruit-flavored candy. The nickname Purple Drank comes from the color of the cough syrup.

How Dangerous is Lean

Codeine is a prescription opioid painkiller just like OxyContin, Vicodin, and fentanyl. It is used to treat acute or chronic pain, and can cause feelings of euphoria and deep relaxation — and is highly addictive. The FDA classifies codeine as a Schedule 2 drug, which means it has a high risk of abuse.

Promethazine is an antihistamine and a central nervous system depressant. Some say that it enhances the hallucinatory effects of codeine. Combined with codeine, promethazine can slow breathing to the point of complete respiratory arrest.

A version of lean is also made from over-the-counter cough syrups that contain dextromethorphan, or DXM. The better known brands are Robitussin, NyQuil, Theraflu, and Delsym. There are even a few generic products that contain both DXM and promethazine. DXM can cause loss of coordination, numbness, nausea, increased blood pressure and heart rate, and elevated body temperature. In extreme doses, DXM causes effects similar to PCP: psychosis, dissociation, violent behavior, and possibly cardiac arrest.

Side Effects of Lean and Risk of Overdose

Lean is a popular drug among teens and young adults who often combine lean with marijuana or alcohol to intensify the high. Mixing lean (or any opioid) with alcohol significantly increases the risk of overdose, as alcohol amplifies the effects of opiates. Lean can also adversely interact with antidepressants, mood stabilizers, benzodiazepines, or herbal supplements like melatonin or valerian root. It may seem less harmful than heroin or cocaine, but the typical user takes up to 25 times the recommended dosage of the cough syrup, so it can have some serious side effects.

The taste of the cough syrup is covered by the soda and candy, so it goes down easily. Lean causes rapid, acute intoxication if consumed in large amounts. The effects include blurred vision, sleepiness, impaired motor function, loss of inhibitions, nausea, memory problems, confusion, disorientation, feelings of dissociation, and hallucinations.

Signs of overdose include poor physical coordination, stomach cramps, vomiting, dilated pupils, slurred speech, hallucinations, extreme lethargy or unconsciousness, cyanosis (bluish color of the lips and fingernails), heart arrhythmia, low blood pressure, respiratory distress, or seizures. Overdose can lead to brain damage, organ damage, coma, or death by cardiac arrest or respiratory failure.

Lean Withdrawal and Addiction Treatment

All opioids are highly addictive, and this addiction is extremely difficult to overcome because of the strong, painful withdrawal symptoms it produces. Detoxing should be done at a rehab center where medical staff will monitor the patient to ensure safety, comfort, and a reduced risk of relapse. Many who try to detox at home relapse almost immediately because of the withdrawal symptoms.

Codeine withdrawal symptoms include agitation, anxiety, muscle aches, watery eyes, insomnia, runny nose, sweating, abdominal cramps, diarrhea, nausea, vomiting, and seizures caused by dehydration.

Once the physical dependency is beaten, addiction therapy combining personal/group therapy sessions with life skills and stress management training is recommended. An individualized aftercare program that includes peer support or 12-step groups and follow up counseling sessions should be developed.

Lean addiction is not as highly publicized as other forms of opioid abuse but it is just as difficult to overcome, and just as deadly.

Into Action Recovery Centers takes pride in providing a high level of treatment and a holistic approach to recovery for those who suffer from addiction. Our comfortable facility is designed with the client’s needs foremost in mind. Our staff includes master’s level counselors, licensed chemical dependency counselors, 24-hour nursing professionals, a staff psychiatrist, a staff chef, and direct care personnel. Our counseling staff provides individualized treatment and care for our clients with an emphasis on tailoring treatment to the specific needs of each individual. Additionally, our staff provides family counseling, relapse prevention, life skills, and grief and trauma counseling.

Into Action Recovery Centers provides an abstinence-based program and all of our staff members have a strong understanding of the recovery process through personal experience. We are passionate about sharing the process involved in living a drug and alcohol-free life. We offer free aftercare for the men who complete our program and have a strong alumni network that remains active in the community. We also offer other amenities such as dietician-prepared meals, mindfulness-based meditation training, outings, and fitness training.


Dr. Mohammed Saeed, MD.

Dr. Saeed is a psychiatry specialist with over 40 years of experience in the medical field. He received training in General Psychiatry at the University of Texas Medical Branch, where he was selected as the Medical Director of the Division of Child and Adolescent Psychiatry. He currently serves as the medical director at Into Action Recovery Centers. Full Bio

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