Updated on February 6, 2024
4 min read

How to Identify and Treat Codeine Cough Syrup Addiction

What is Lean, Purple Drank, Sizzurp?

Lean is the street name for a concoction made by mixing cough syrup, soda, hard candy, and sometimes alcohol. Mixing the syrup with soda or alcohol can offset the bitter taste of cough medication.

Cough syrup typically contains codeine, a prescription opioid used to treat mild to moderate pain. Codeine is often misused because of the drug's ability to change how the brain and central nervous system (CNS) respond to pain.

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

  • Sizzurp 
  • Purple drank 
  • Barre
  • Texas tea

However, the U.S. Food and Drug Administration (FDA) has restricted prescription cough syrup containing codeine and tramadol pain medications in children. It has also required labeling changes for opioid cough and cold medicines.

Is Codeine Cough Syrup Abuse Common?

Misuse of codeine cough syrup still occurs frequently in the U.S. Because of how hip-hop and rap communities have glamorized lean, it has become popular among American youth.

Current state laws require a doctor’s prescription before a person can obtain any type of product containing codeine. Because 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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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.

When misused, however, it can lead to serious side effects and physical dependence. Other cough syrups, like those containing dextromethorphan (DXM), can also harm your health.

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 difficulty breathing 
  • Loss of muscle tone
  • Cold and clammy skin 
  • Mood swings
  • Appearing 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. 

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. 

Codeine Withdrawal Symptoms

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 heart rate
  • Muscle soreness
  • Dilated pupils
  • Goosebumps
  • Appetite loss
  • 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 to get off the substance in a safe, controlled way. 

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Treatment Options for Codeine and DXM Addiction

Available treatment options for codeine addiction include:

Unlike codeine, there are no medications to treat DXM addiction. Your healthcare specialist may recommend CBT or contingency management to help you or your loved one with recovery.

“Robotripping” with DXM Cough Medicine

Because it's harder to get codeine cough syrup, there has been an increase in the misuse of over-the-counter (OTC) medicines. This is particularly true about ones containing dextromethorphan (DXM), such as Robitussin and NyQuil.

Although common and safe when used as indicated, DXM can distort the perception of time and cause hallucinations. In large doses, DXM causes hallucinogenic effects similar to PCP and ketamine.

The misuse of DXM can also lead to an increased risk of:

  • Respiratory distress
  • Seizures
  • Elevated heart rate due to antihistamines

These OTC cough suppressant characteristics have led to a popular trend called robotripping or skittling.

Side Effects of DXM Abuse

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
  • Vision changes
  • 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. 

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Updated on February 6, 2024

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