What Is Codeine-Containing Cough Syrup ("Lean") Addiction?
Lean, also called "purple drank," "sizzurp," or "syrup," is recreational abuse of prescription cough syrup containing codeine and promethazine, typically mixed with candy (particularly Jolly Ranchers) or soft drinks for palatability. Codeine is a prodrug that is metabolized by the liver to morphine, producing opioid effects, while promethazine is an antihistamine with sedative properties. The combination produces euphoria, sedation, and dissociation; users seek the combination specifically for the intensified effects. Lean abuse has been glamorized in hip-hop culture, particularly in Southern states including Texas and Georgia, with increased prevalence across the United States among younger users. Access to codeine-promethazine cough syrup has been restricted in many settings, but the drug remains prescribed for legitimate medical purposes and can be diverted. Additionally, some users progress from lean abuse to use of other opioids including heroin and fentanyl. Lean addiction is a genuine opioid use disorder that deserves the same evidence-based treatment as any other opioid addiction. At Trust SoCal, we provide specialized treatment for codeine and lean addiction with medical detox and medication-assisted treatment.
