Lean, also called purple drank or sizzurp, is a recreational drug made by mixing prescription cough syrup containing codeine and promethazine with soda and sometimes hard candy. It’s dangerous because its two active ingredients work together to suppress breathing, and the casual way it’s consumed (sipped from a styrofoam cup at a party) disguises just how easy it is to overdose. The drink has been linked to drowsiness, hallucinations, neurological damage, and death.
What’s Actually in Lean
The core ingredient is prescription-strength cough syrup containing two drugs: codeine phosphate (an opioid) and promethazine hydrochloride (a sedating antihistamine). A standard formulation contains 10 mg of codeine and 6.25 mg of promethazine per teaspoon, along with 7% alcohol. That works out to roughly 60 mg of codeine and 37 mg of promethazine per fluid ounce of syrup.
Those numbers matter because lean isn’t sipped by the teaspoon. Users typically pour several ounces of syrup into a large cup of soda, meaning a single serving can contain hundreds of milligrams of codeine. At those doses, codeine stops being a cough suppressant and starts acting as a full-strength opioid, producing euphoria, extreme sedation, and dangerous respiratory depression. The soda and candy mask the medicinal taste, making it easy to drink far more than intended.
How Lean Suppresses Breathing
The most immediate danger of lean is what it does to your ability to breathe. Codeine acts directly on the brain stem, the part of your brain that automatically controls the rhythm and depth of your breathing. It makes the brain stem less responsive to rising carbon dioxide levels in your blood, which is the signal your body normally uses to tell you to breathe harder. The result is breathing that becomes slow, shallow, and irregular.
Promethazine makes this worse. It has its own independent depressant effect on the respiratory center, and that effect stacks on top of what codeine is already doing. It also intensifies and prolongs the sedative action of opioids like codeine. So you’re not just taking two drugs at once. You’re taking two drugs that amplify each other’s most dangerous effect. This additive suppression is what makes lean more unpredictable than codeine alone, and it’s a major reason people stop breathing after drinking it.
Immediate Side Effects
Even at doses that don’t cause an overdose, lean produces a range of unpleasant and risky effects. The most common include heavy drowsiness, slowed heart rate, and impaired coordination. Some users experience hallucinations and confusion. Promethazine on its own can cause tachycardia (a racing heartbeat) and delirium at toxic levels, which creates a confusing picture: your brain is sedated while your heart is racing.
Promethazine also amplifies the effects of other central nervous system depressants, including alcohol. Since the syrup itself already contains 7% alcohol, and users often mix it with other substances, the sedation can compound quickly and unpredictably. Nausea, constipation, blurred vision, and dizziness are also common, even from a single use.
Overdose Signs
A lean overdose is a medical emergency, and it can happen faster than most users expect. The warning signs fall into three categories. Breathing becomes slow, labored, or shallow, and in severe cases stops entirely. Blood pressure drops severely and the pulse becomes weak. The person loses consciousness or slips into a coma. Because lean is sipped slowly over hours, people sometimes don’t realize they’ve overdosed until they’re already in serious trouble. The sedation from promethazine can also mask the early warning signs, keeping someone too drowsy to recognize that their breathing is failing.
Codeine Addiction and Withdrawal
Codeine is an opioid, and regular use builds physical dependence just like heroin or morphine. The World Health Organization classifies codeine alongside those drugs for a reason. Your body adapts to the presence of the drug, and when you stop, withdrawal hits.
Codeine is a short-acting opioid, so withdrawal symptoms typically begin 8 to 24 hours after the last dose and last 4 to 10 days. Early symptoms include anxiety, muscle aches, sweating, and insomnia. As withdrawal progresses, nausea, vomiting, diarrhea, and intense cravings follow. The withdrawal itself isn’t usually life-threatening, but it’s miserable enough that many people keep using just to avoid it, which is how casual sipping turns into a daily habit.
Tolerance also builds steadily. The same amount of lean that once produced a pleasant high stops working, pushing users to drink more. This escalation is what turns recreational use into a genuine overdose risk over time.
Damage to Teeth
Lean is typically mixed with soda and dissolved hard candy, creating an extremely sugary drink that users sip slowly over hours. This is essentially the worst possible combination for your teeth. The acids in soft drinks erode tooth enamel directly, while the high sugar content feeds the bacteria that cause cavities. Studies have found that the cariogenic potential of cola is actually higher than that of milk or plain sucrose, and prolonged exposure (like slowly sipping a cup over an entire evening) maximizes the damage. Chronic lean users often develop severe tooth decay comparable to what’s seen in heavy soda drinkers, with visible erosion, cavities, and gum disease.
Neurological and Organ Risks
Repeated lean use has been linked to neuropsychological complications. The combination of chronic opioid exposure and promethazine’s effects on dopamine receptors and other brain systems can impair cognition, mood regulation, and decision-making over time. Promethazine acts as an antagonist at dopamine receptors in the brain’s reward pathways, which with repeated use can disrupt normal motivation and emotional processing.
The codeine in lean is metabolized by the liver, and chronic use puts sustained stress on that organ, particularly because the syrup also contains alcohol. Constipation from regular opioid use can become severe and chronic, leading to bowel complications. The cumulative toll on the body adds up in ways that aren’t obvious until significant damage has already occurred.
Legal Consequences
Promethazine with codeine syrup is a Schedule V controlled substance under the DEA’s classification system. That’s the lowest schedule, but it still requires a prescription. Possessing it without one is a criminal offense in every U.S. state, and because lean has become closely associated with drug culture, law enforcement often treats it seriously. Selling or distributing prescription cough syrup carries stiffer penalties, and in some jurisdictions, large quantities can trigger felony charges.
The Schedule V classification sometimes creates a false sense of safety, as if the government considers it barely dangerous. In reality, the scheduling reflects the drug’s accepted medical use at prescribed doses, not its safety profile when someone pours four ounces into a cup of Sprite. At recreational doses, lean behaves like a much more dangerous drug than its legal classification suggests.