Lean: What It Is, Effects, And Risks - Medical News Today

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Medical News TodaySubscribeWhat to know about lean

Medically reviewed by Philip Ngo, PharmD — Written by Zawn Villines — Updated on May 30, 2025

What is it?
Origins
Effects
Short-term risks
Long-term effects
Addiction
Help with addiction
Summary

Lean is a mixture of codeine and other ingredients, such as soda and candy. It is sometimes called purple drank or sizzurp. Potential effects include pain relief, altered states of consciousness, addiction, and overdose.

The exact formula of lean varies, but users typically mix soda or other sweet ingredients with cough syrup that contains codeine, which is an opioid.

Opioids are a class of drugs that act on the nervous system to relieve pain and can be highly addictive.

Several rappers have promoted lean as both a recreational drug and a source of creative inspiration. However, lean can be deadly in high doses, and chronic use may lead to codeine addiction.

Help is available

Seeking help for addiction may feel daunting or even scary, but several organizations can provide support.

If you believe that you or someone close to you is showing signs of addiction, you can contact the following organizations for immediate help and advice:

Substance Abuse and Mental Health Services Administration (SAMHSA): 800-662-4357 (TTY: 800-487-4889)
988 Suicide & Crisis Lifeline: 988

What is lean?

Bottles of cough syrup and soda next to cups of ice.-2 — I_will_be_RB/Getty Images

Lean is typically a very sweet drink that blends soda with cough syrup containing codeine. Some formulas also add candy or sweetening syrup.

Users may also mix in promethazine, which is an antihistamine that may strengthen codeine’s effects and make a person feel relaxed and sleepy.

High doses of codeine and promethazine can induce hallucinations, vivid dreams, or nightmares. Some users take the drug specifically for this reason. They may feel that the hallucinations support creative thinking.

Origins and history of lean

Purple drank dates back to at least the 1990s. Its public birth took place in the music scene, with musicians such as Justin Bieber, Lil Nas, and the hip-hop group Three 6 Mafia reportedly using or singing about the drug.

The authors of an older 2014 analysis assert that the drug first became popular in the rap and hip-hop scene in Houston, Texas.

The same analysis found a correlation between a person’s taste in music and their likelihood of using lean among 2,349 university students in the United States. Students who preferred rap or hip-hop and rock or alternative music were more likely to use the drug.

However, a more recent 2024 exploratory study suggests that information on the national use of lean is limited, despite its cultural prominence.

Lean’s effects

Codeine is the most common opioid medication and is even available as an over-the-counter medication in some countries. In the United States, it is only available with a prescription.

As with other opioids, codeine can relieve pain and make a person feel more relaxed. People may feel sleepy when using codeine. Adding promethazine to the mix may increase feelings of sleepiness and relaxation.

Because the exact ingredients that people use in lean vary, the effects may also differ from drink to drink.

According to a 2023 study, the effects of lean may include:

altered states of consciousness, including hallucinations and changes in the way that a person thinks
fatigue and drowsiness
slow or shallow breathing

People may also experience less coughing, as codeine is a cough medication, and a decrease in congestion because of the antihistamine effects of promethazine.

Since it contains codeine, lean also poses a risk of overdose, which can be life threatening.

According to the Centers for Disease Control and Prevention, 107,941 people died from drug overdoses in 2022, and 76% of these overdoses involved opioids.

Short-term risks and side effects

The short-term side effects of lean may include:

pregnancy complications, such as:
- preterm birth
- low birth weight
- brain injury to the fetus
- death of the newborn infant
slow breathing that may become life threatening in people with certain conditions, such as sleep apnea
changes in consciousness
pinpoint pupils
constipation
nausea or vomiting
allergic reactions, in some people
overdose at high doses or when in combination with other drugs
blurred vision
itchy skin
shaking
pancreatitis
abdominal cramps
inability to urinate

The above effects may also increase the risk of harm when carrying out certain activities, such as driving or using heavy machinery.

Effects of lean with alcohol and other drugs

Using other drugs with lean may worsen any adverse effects or cause additional side effects.

Mixing alcohol with codeine, for example, can increase the risk of severe drowsiness, breathing problems, and life threatening overdose.

Using any drug with lean may also increase the risk of liver or kidney damage.

Long-term risks and side effects

One of the most significant side effects of long-term use of lean is addiction. Addiction may also increase the risk of overdose because a person may need to use progressively more purple drank to get the same effects that they once got with a lower dose.

Some other long-term risks of lean include:

male infertility, which may be due to oxidative stress damaging sperm
changes in sex drive
sexual dysfunction
organ damage

As lean slows down activity in the brain and nervous system, taking it with other drugs that have sedating effects can be harmful.

Anxiety drugs, such as benzodiazepines, sleeping pills, and sedatives, are especially dangerous. Using other opioids, such as fentanyl or heroin, increases the risk of breathing problems and fatal overdose.

Is lean addictive?

People who think that they have an addiction to lean are usually addicted to its active ingredient, codeine. Like other opioids, codeine has a high risk of addiction.

The sweet flavor of lean’s other additives, such as soda and candy, may entice users to try or continue using the drink, furthering the risk of addiction.

Promethazine is a popular additive to lean. Some users may also intentionally misuse promethazine because of its sedative effects. Doing this may lead to dependence on promethazine and codeine.

Some signs that a person may have an addiction to either lean or the drugs that it contains include:

needing lean to feel “normal”
spending significant time and money trying to access lean or its ingredients
continuing to use the drug despite negative consequences, such as health issues or relationship problems
trying to stop using lean but being unable to do so
using lean on a regular, daily basis
experiencing withdrawal symptoms when they discontinue use

Addiction treatment

The treatment for codeine addiction may focus on reducing dependence on the drug, managing any withdrawal symptoms, and treating underlying conditions that may have contributed to addiction.

Addiction treatment may vary from person to person depending on their situation and what works for them.

Some strategies that may help include:

Addiction support groups: Peers can provide support to help people with a drug use disorder feel less alone and offer practical insight for coming off the drug.
Therapy: Therapy may help a person understand what triggered their use of the drug, in addition to offering practical support as they work to reduce their dependence.
Medication: Some people use lean to cope with an underlying medical condition. A healthcare professional may be able to prescribe safer medications to address these underlying issues.
Lifestyle changes: Some people find that avoiding people who use lean helps them maintain recovery. Others may find that exercise and dietary changes ease withdrawal symptoms.

People who want help with addiction can search for a treatment facility near them. They can also contact the Substance Abuse and Mental Health Services Administration national helpline at 800-662-4357 (TTY: 800-487-4889).

Summary

Although popular culture often portrays lean as a harmless, sugary way to spur creative thinking, it contains an opioid, which can cause side effects and addiction.

Users can die of codeine overdose or from organ failure due to chronic overuse. Preparations of lean can also vary significantly and may sometimes contain other harmful substances.

People who want help managing a dependence on lean or codeine can speak with a healthcare professional or support organization for help.

Alcohol / Addiction / Illegal Drugs

How we reviewed this article:

SourcesMedical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

About overdose prevention. (2025).https://www.cdc.gov/overdose-prevention/about/index.html
Ajayi AF, et al. (2020). Codeine-induced sperm DNA damage is mediated predominantly by oxidative stress rather than apoptosis.https://pmc.ncbi.nlm.nih.gov/articles/PMC7189206/
Chiappini S, et al. (2021). Beyond the ‘purple drank’: Study of promethazine abuse according to the European Medicines Agency adverse drug reaction reports.https://pmc.ncbi.nlm.nih.gov/articles/PMC8278560/
Hart M, et al. (2013). ‘Me and my drank:’ Exploring the relationship between musical preferences and purple drank experimentation.https://link.springer.com/article/10.1007/s12103-013-9213-7
Miuli A, et al. (2020). "Purple drank" (codeine and promethazine cough syrup): A systematic review of a social phenomenon with medical implications.https://pubmed.ncbi.nlm.nih.gov/32748711/
Peechakara BV, et al. (2024). Codeine.https://www.ncbi.nlm.nih.gov/books/NBK526029/
Ware OD. (2023). Lean/sizzurp ingredients, use, and coping with mental health symptoms.https://pmc.ncbi.nlm.nih.gov/articles/PMC10517614/
Ware OD, et al. (2024). Codeine and promethazine: Exploratory study on “lean” or “sizzurp” using national survey data and an online forum.https://pmc.ncbi.nlm.nih.gov/articles/PMC10962845/

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Medically reviewed by Philip Ngo, PharmD — Written by Zawn Villines — Updated on May 30, 2025

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What is lean?

Origins and history of lean

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Effects of lean with alcohol and other drugs

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Is lean addictive?

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