What Is Lean? The Dangers of This Addictive Drink

In pop culture and music, “lean” might sound harmless — sometimes even glamorous. But behind the catchy name is a mixture of dangerous and addictive substances that can cause serious health issues.

If you or someone you love is struggling with abuse or addiction to lean, it’s crucial to understand what it is, its long-term effects, and how to get help for dependence.

What is Lean?

Lean, also known as purple drank, sizzurp, or dirty Sprite, is a recreational drink made by mixing prescription-strength cough syrup (which contains codeine and promethazine) with a soft drink, typically Sprite or other clear lemon-lime flavored soda. Sweet candy is often added for flavor. The codeine in lean is an opioid, while promethazine is an antihistamine with sedative effects. Together, they produce a drowsy, euphoric high that some people find relaxing or intoxicating.

Originally popularized in Southern hip-hop culture, the use of lean has spread widely through social media, and the drink is often referenced in popular music. But the health and addiction risks it carries are rarely highlighted.

Is Lean Addictive?

Yes. Lean is highly addictive. The main ingredient, codeine, is an opioid. Like other opioids — such as oxycodone or heroin — codeine can create physical dependence and addiction. When consumed repeatedly, the brain adjusts to the presence of codeine and craves more and more of it to feel the same effects.

A study in the Journal of Psychoactive Drugs found that nearly 60% of young adults who use codeine cough syrup recreationally show signs of opioid dependence (Novak et al., J Psychoactive Drugs, Vol. 41). This highlights how easily recreational use can spiral into physical addiction, withdrawal symptoms, and cravings that are hard to control.

The Health Dangers of Lean

While lean might seem like just a sweet drink, it poses severe short- and long-term risks:

1. Respiratory depression + overdose

Codeine suppresses the central nervous system, slowing breathing and heart rate. Taken in high doses or mixed with other depressants (like alcohol or benzodiazepines), lean can cause breathing to stop altogether, leading to fatal overdose. A Drug and Alcohol Dependence study found that codeine cough syrup misuse contributed to a 21% increase in opioid-related emergency visits among young adults over a five-year period (McCabe et al., Drug Alcohol Depend, Vol. 150).

2. Brain + mental health effects

Chronic use of lean can affect memory, concentration, and mood. Frequent use is linked to higher rates of depression and anxiety. Long-term abuse may even lead to opioid-induced hyperalgesia, where the body becomes more sensitive to pain.

3. Liver + organ damage

Some cough syrups used to make lean contain high doses of acetaminophen, which can severely damage the liver. According to the American Journal of Therapeutics, codeine cough syrup misuse is associated with a 23% increased risk of liver toxicity due to excessive acetaminophen intake (Larson et al., Am J Ther, Vol. 19).

4. Dangerous additives

Lean is often mixed with alcohol or other drugs to intensify its effects, greatly increasing the risk of overdose or dangerous interactions. The sugary sodas and candies added to lean can also contribute to poor dental health and metabolic problems over time.

Long-term Health Risks

Repeated use of lean can lead to long-lasting physical and psychological harm. Over time, users often develop tolerance, requiring higher doses to achieve the same effect. Withdrawal symptoms — nausea, muscle aches, anxiety, and insomnia — make quitting lean extremely difficult without help.

Research in the Substance Use & Misuse journal found that chronic lean users were 2.5 times more likely to experience opioid withdrawal symptoms compared to non-users (Hughes et al., Subst Use Misuse, Vol. 51). The cycle of craving, using, and withdrawal traps many individuals in addiction for years.

Why is Lean so Popular?

Lean’s popularity is driven partly by pop culture and social media, which often glamorize it without showing its dangers. Many young people see artists or influencers with foam cups and colorful drinks, but don’t see the hospital stays, withdrawals, or overdoses that happen behind the scenes.

Because lean is made with prescription medications, some mistakenly believe it’s safer than street drugs. In reality, it carries the same risks as other opioids — addiction, overdose, and even death.

Breaking the Cycle of Lean Addiction: Support Starts Here

Severe or long-term lean addiction may require medical detox before longer-term addiction treatment can begin. Lean contains codeine, which is an opioid. When an individual’s body becomes dependent on opioids, stopping use suddenly can cause withdrawal symptoms such as intense cravings, nausea, vomiting, muscle aches, anxiety, insomnia, and more. While withdrawal from codeine is generally less severe than from stronger opioids like heroin or fentanyl, it can still be intensely uncomfortable and even medically risky without the support of medical professionals.

At STR Silver Pines, a leading psychiatric and addiction treatment center in Pennsylvania, we offer evidence-based care for individuals struggling with lean abuse and other forms of opioid use disorder. Our treatment includes medical detox, medication-assisted treatment (MAT), and trauma-informed therapy in a safe, supportive setting.

If you or someone you care about is struggling with lean addiction, don’t wait. Reach out today and start your path to recovery.

References

• Novak SP et al., “Recreational Use of Cough Syrup,” J Psychoactive Drugs, Vol. 41
• McCabe SE et al., “Trends in Nonmedical Use of Codeine,” Drug Alcohol Depend, Vol. 150
• Larson AM et al., “Acetaminophen Toxicity,” Am J Ther, Vol. 19
• Hughes JR et al., “Lean Use and Withdrawal,” Subst Use Misuse, Vol. 51