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Lean. Purple Drank. Sizzurp. The cough syrup-soda-hard candy mixture is known in popular culture by many names. The concoction’s been glorified in songs like Three 6 Mafia’s “Sippin on Some Sizzurp” and in lyrics from Far East Movement’s 4 times platinum hit “Like a G6” (sippin sizzurp in my ride / like Three 6) and Lil Wayne’s “Turn on the Lights” (I’m purple drank forever). Countless celebrities, including Rob Kardashian, Soulja Boy, and Justin Bieber, have posed with the drink on Instagram. It seems, in recent years, pop culture has forgotten that lean is still a dangerous drug and potentially fatal.
The earliest references to purple drank came from Houston’s blues musicians. At the time, it referred to Robitussin mixed with beer. In the 1980s, sizzurp – a mixture of codeine cough syrup, soda, and a Jolly Rancher for added sweetness – grew in popularity among southern rappers. Today, lean is abused in large numbers by young people across the globe. For instance, in Australia, codeine-related deaths doubled between 2000 and 2009.
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Because codeine is among the weaker analgesics, people often forget that it is still an opioid. The body recognizes and responds to codeine in the same way it does other synthetic and prescription opioids. Accordingly, the effects of consuming codeine (especially in large quantities) are similar to those of morphine or heroin.
The effects of drinking lean include:
Unfortunately, this means that codeine also has the potential to be highly addictive. Over time, an individual drinking lean will need to drink more and more to get the same feeling, or even to feel normal. This is known as a tolerance. A tolerance to codeine is one of the primary signs of addiction. Opioid-related overdose and death statistics include codeine in the data.
In recommended doses, codeine cough syrup is safe to use. However, the inordinate amount of codeine in lean (up to 25 times the recommended dose) can lead to brain or bodily damage and overdose.
There’s a misconception that codeine is a weaker formula of the same class of medicine [as heroin]. But the amount of codeine these guys ingest with the syrup is massive … it’s just the same as someone being addicted to heroin, except they’re not using needles.
Like other opioids, codeine reduces a person’s lung function and slows breathing. What’s worse, many mix alcohol and crush painkillers into their lean. Alcohol and painkillers (often prescription opioids) are also central nervous system depressants and can slow breathing even further. This combination dramatically increases the risk of fatal overdose.
Codeine isn’t the only potentially dangerous drug in lean. Promethazine, another central nervous system depressant, is typically used as an antihistamine and to treat nausea. Its sedative-like effects are intended to prevent people from abusing it in large quantities. In conjunction with codeine, promethazine can slow breathing to the point of complete respiratory arrest. Some have reported that promethazine exaggerates the hallucinatory effects of codeine.
Taken together, side effects will kick in within 20 to 45 minutes, peak between 1 to 2 hours, and last for approximately 4 to 6 hours.
If an individual suffering from a codeine addiction stops or cuts back suddenly, they will experience symptoms of withdrawal. Withdrawal from opioids, even codeine, is one of the hardest to endure for people recovering from an opioid addiction. People have described it as the “worst flu when you’re shivering, you’re vomiting, you can’t eat, you have diarrhea, every atom in your body hurts, you can’t sleep, you lie on the floor just shivering … and multiply that times a million.”
Codeine is a short-acting opioid, meaning symptoms of withdrawal usually start within 12 hours of last use. Symptoms of codeine withdrawal can be severe enough to require medical supervision at a rehab facility.
Codeine withdrawal symptoms within the first two days include:
Codeine withdrawal symptoms between days 2 and 5 include:
Possible complications involve lung infections caused by vomiting and extreme dehydration from vomiting and diarrhea. Severe dehydration can cause seizures.
Even when lean doesn’t contain large doses of codeine or promethazine, it is still a potentially fatal substance. The other common form of lean includes dextromethorphan (usually sold in capsules), a cough suppressant. DXM is an over-the-counter (OTC) cough medicine present in NyQuil®, Robitussin®, and Theraflu®. It acts on the same brain receptors as dissociative drugs like ketamine or PCP. DXM, like codeine, can increase amounts of dopamine (a pleasure chemical) released by the brain. The dopamine release and reward system is one of the major causes of addiction.
DXM side effects include:
Drinking lean may not seem like a big deal, and quitting might seem easy. However, an addiction to any opioid can be serious and life-threatening.
[Quitting syrup] feels like death in your stomach when you stop. Everybody wants me to stop all this and all that. It ain’t that easy.
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