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Updated on March 4, 2022

Codeine Cough Syrup (Lean, Purple Drank, Sizzurp)

What is Lean, Purple Drank, Sizzurp?

Lean is the street name for codeine, a type of prescription opioid used to treat mild to moderate pain. When combined with other types of medications like cough syrup, codeine can fight the effects of coughing and provide temporary relief.

However, given the drug’s ability to change how the brain and central nervous system (CNS) respond to pain, some people misuse or abuse codeine.

By mixing the syrup with soda or alcoholic drinks, they can offset the bitter taste typically associated with the cough medication, producing lean.

Aside from lean, other street names used to describe this liquid combination include:  

  • Sizzurp 
  • Purple drank 
  • Barre
  • Texas tea

In recent years, this dangerous combination has become more popular among America’s youth. Hip-hop communities and rappers have glamorized the drink to make it the intoxicant of choice.

Although states have enacted laws to restrict sales of products with codeine, other cough syrups, like those containing dextromethorphan (DXM), can still be harmful to health when misused. 

The FDA has restricted the use of prescription cough syrup containing codeine, along with other codeine and tramadol pain medications in children. It has also required labeling changes for opioid cough and cold medicines.

Lean Effects

Lean has a euphoric effect similar to the high that other opioid pain medications produce.

Users enjoy the calming effects that kick in approximately 30 minutes after consuming the drink. It's often called "lean" because it causes people to slouch, lean, and sit down due to intense intoxication.

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Dangers and Side Effects of Cough Syrup Abuse

Codeine is the least potent of all prescription opiates. Some people may also consider it to be less harmful than other opiates. However, it can lead to serious side effects and physical dependence when misused. 

Some of these side effects include:

  • Nausea
  • Diarrhea
  • Decreased appetite and weight loss
  • Drowsiness
  • Dizziness
  • Low blood pressure
  • Itching and rash
  • Seizure
  • Breathing problems, such as slow or difficulties breathing 
  • Loss of muscle tone
  • Cold and clammy skin 
  • Mood swings
  • Appear distant or “out of it”
  • Neglect of family, work or social obligations

Taking alcohol or other drugs can increase the risk of these serious, life-threatening side effects. The combination of alcohol and codeine can greatly reduce the amount of oxygen circulating throughout the body and brain. This can cause long-term damage to major organs or even death. 

Is Codeine Cough Syrup Abuse Common?

Misuse of codeine cough syrup still occurs frequently in the United States.

Current state laws require a doctor’s prescription before a person can obtain any type of product containing codeine. However, codeine drug abuse is growing in popularity among American youth.

Since it's so difficult to obtain codeine cough syrup, some people visit different physicians to request prescriptions. This is referred to as doctor shopping

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“Robotripping” with DXM Cough Medicine

The challenge faced in obtaining codeine cough syrup has seen an increase in the misuse of over-the-counter medicines containing dextromethorphan (DXM) such as Robitussin and NyQuil.

Although common and safe when used as indicated, DXM has the capacity to distort the perception of time and cause hallucinations. 

In large doses, DXM causes some hallucinogenic effects that are similar to PCP and ketamine. The misuse of DXM can also lead to an increased risk of respiratory distress, seizures, and elevated heart rate due to the antihistamines in cough medication. 

These characteristics of the over-the-counter (OTC) cough suppressant have led to a popular trend called robotripping or skittling.

Similar to codeine cough syrup abuse, users will consume more than the recommended dosage of DXM to experience psychological and physical effects. These include numbness, the sensation of detachment from self and environment, and invulnerability. 

Other, less pleasant side effects of DXM misuse can include:

  • Extreme panic 
  • Paranoia 
  • Impaired judgment 
  • Anxiety 
  • Aggressive behavior 
  • Lethargy
  • Changes in vision
  • Sweating 
  • Poor motor skills

Robotripping is a dangerous activity not only because of the misuse of DXM. Medications containing DXM may also have other active ingredients like acetaminophen or guaifenesin that, in higher doses, can lead to additional adverse effects. 

When is Addiction Treatment Necessary?

Misusing products that contain codeine or DXM can result in serious, long-term health problems. It can also lead to physical dependence, abuse, or overdose. If you or a loved one are experiencing some of the signs and symptoms of codeine addiction, seek professional medical help. 

Going “cold turkey” or deciding to suddenly stop using codeine and DXM can cause serious withdrawal symptoms and lead to an unintentional overdose.

Withdrawal symptoms include:

  • Irritability or anxiety
  • Runny nose
  • Sweating
  • Fatigue
  • Increased heartrate
  • Muscle soreness
  • Dilated pupils
  • Goosebumps
  • Loss of apetite
  • Nausea
  • Teary eyes
  • Stomach cramps

Those with withdrawal symptoms may experience a “rebound effect,” in which symptoms that were either absent or controlled due to medication reappear. 

For these reasons, it's important to see a healthcare professional so that you can get off the substance in a safe and controlled way. 

Unlike codeine which has medication treatment options, there are no medications to treat DXM addiction. However, your healthcare specialist may recommend cognitive behavioral therapy (CBT) or contingency management to accompany you or your loved one in your path to recovery.

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Treatment Options for Opioid Abuse & Addiction

There are several options for people suffering from opioid addiction. These include:

Medication-Assisted Therapy (MAT)

There are three medications approved to treat opioid use disorder: buprenorphine, methadone, and naltrexone. These medications are used only with medical supervision.

Buprenorphine and methadone can help you manage withdrawal symptoms throughout the detoxification process. Because of this, a person experiences reduced cravings for opioids, thereby restoring balance in the brain circuits.

Naltrexone is less commonly used, but it blocks your opioid receptors, making it impossible to get high. Medication-assisted therapy is most effective when combined with other forms of treatment.

Inpatient Programs

Inpatient programs are the most intensive and effective treatment options for opioid addiction.

These programs guide you through medically supervised detoxification, then behavioral therapy and other services (possibly including MAT), will be added to your treatment.

They typically last 30, 60, or 90 days. However, they may be longer if necessary.

Partial Hospitalization Programs (PHPs)

PHPs are also known as intensive outpatient programs (IOPs). They are the next most intensive type of treatment for opioid addiction.

They provide similar services to inpatient programs such as detoxification, behavioral therapy medical services, and custom treatments such as MAT.

The difference is that in a PHP, the patient returns home to sleep. Some programs will include transportation and meals, but this varies by program.

Partial hospitalization programs are helpful for both new patients and patients who have completed inpatient treatment and still need intensive recovery therapy.

Outpatient Programs

Outpatient programs work best for people who have a high level of motivation to recover. They create treatment programs that work around your schedule.

These programs can either be an effective treatment option for new patients or a part of an aftercare program for people who complete inpatient or partial hospitalization programs.

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Resources

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  1. National Institute on Drug Abuse. “Over-the-Counter Medicines DrugFacts.” National Institute on Drug Abuse, 16 June 2020, www.drugabuse.gov/publications/drugfacts/over-counter-medicines.
  2. “Cough Medicine Abuse by Teens.” Content - Health Encyclopedia - University of Rochester Medical Center, University of Rochester Medical Center, www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=1.
  3. “Codeine: MedlinePlus Drug Information.” MedlinePlus, U.S. National Library of Medicine, 15 Mar. 2018, medlineplus.gov/druginfo/meds/a682065.html.
  4. Sanneh, Kelefa. “The Woozy, Syrupy Sound of Codeine Rap.” The New York Times, The New York Times, 18 Apr. 2004, www.nytimes.com/2004/04/18/arts/music-the-woozy-syrupy-sound-of-codeine-rap.html.

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