Substance guides

What is lean? The dangers of purple drank

Published October 15, 2024 · 7 min read · Updated April 2026

Reviewed for accuracy by licensed clinical professionals.

Lean (purple drank, sizzurp) is prescription cough syrup containing codeine and promethazine mixed with soda and candy. It produces a euphoric, sedated high.

Why it is dangerous

Codeine is an opioid metabolized into morphine. Promethazine amplifies sedation. Together they cause significant respiratory depression, especially combined with alcohol. Multiple celebrity deaths linked to lean.

Addiction pathway

Codeine produces opioid dependence. Tolerance to lean may drive escalation to oxycodone, heroin, or fentanyl. Cultural normalization in music obscures genuine danger.

Treatment

Treated as opioid use disorder. MAT with buprenorphine is effective. Outpatient treatment typically appropriate unless escalated to stronger opioids.

Authoritative sources

This article references guidelines from: NIDA · SAMHSA · CDC

Frequently asked questions

What is lean made of?

Prescription cough syrup with codeine and promethazine mixed with soda and candy.

Is lean addictive?

Yes. Codeine produces opioid dependence that can escalate to stronger opioid use.

Can lean kill you?

Yes. Respiratory depression from codeine and promethazine can be fatal.

Disclaimer: Informational only. Not medical advice. SAMHSA: 1-800-662-4357.