A lean drink usually contains opioid cough syrup mixed with soda, sometimes with candy. Codeine and promethazine are the classic ingredients, though mixtures vary. Codeine is an opioid. Promethazine is a sedating antihistamine that can cause heavy drowsiness.
Teens may call it lean, purple drank, sizzurp, or dirty sprite. Because it starts as a pharmacy drug, a teen may think it is safe. If you find signs of it at home, it helps to know how prescription drug addiction treatment for teens works.
What Is a Lean Drink?
Lean is a recreational drink usually made from codeine promethazine cough syrup and a soft drink, such as lemon-lime soda. Some syrups make it purple, but the color and ingredients vary. Soda and candy can mask the medicine’s taste.
Codeine is the primary ingredient people want for its opioid effects. Doctors use codeine syrup to suppress coughing. Codeine also gives pain relief. Promethazine treats allergies, nausea, and motion sickness. It also makes people drowsy and adds a heavy calm to the high.
Lean is one of many risks in the teen years. A broader look at the signs of drug use in teens can help you put a single clue in context.
Purple Drank, Sizzurp, and Other Names
Common street names include purple drank, sizzurp, dirty sprite, barre, and double cup, and some people call it Texas tea. The drink has been part of hip-hop and pop culture for decades, with early roots in Houston.
A 2023 survey of 1,423 adults who had used lean in the past year found that 77.4 percent were male [1]. The sample came from online forums, so it does not represent all users. It still shows lean use among young adults.
Why Teens Try Lean
Many teens see cough syrup as safer than street drugs because a doctor prescribes it. But codeine is an opioid, in the same drug family as the oxycodone in percs.
Some teens like the slow, relaxed mental state lean brings or use it to cope with stress. Others try it because friends, music, or social media make it look normal.
How Lean Affects the Body
Lean affects the central nervous system: the brain and spinal cord. This system helps control breathing, alertness, and movement.
Both drugs are central nervous system depressants. Together, they can slow the whole body too much. Doctors call this central nervous system depression.
Short-Term Lean Side Effects
Common lean side effects include extreme sleepiness and slurred speech. A teen may also have impaired coordination. Nausea, constipation, and itchy skin are common too.
Lean can also cloud thinking and cause confusion, blurred vision, or hallucinations. Codeine can slow a person’s heart rate and breathing.
Promethazine adds sedating effects on top of the opioid effects. The dose in each drink differs, so the effects are hard to predict. The syrup has no acetaminophen, so its main risk is to breathing, not liver damage.
Is Lean Addictive?
Yes. Repeated codeine use can build tolerance, so a person may need more to feel the same effect. Physical dependence and opioid addiction can also develop. Dependence causes withdrawal when use stops; addiction involves loss of control and continued use despite harm.
The drug label says mild physical dependence can start within a few days of opioid use [2]. It grows much stronger after several weeks. Stopping suddenly then brings opioid withdrawal.
Withdrawal symptoms include anxiety, sweating, muscle aches, cramps, poor sleep, diarrhea, and strong cravings. A doctor should guide quitting lean. Some teens need medical detox.
Withdrawal is one of several signs of opioid use that parents can spot.
Why Lean Is Dangerous
The main danger of lean is respiratory depression. This means breathing gets too slow or too shallow. Severe respiratory depression can starve the brain of oxygen and can kill.
Mixing Lean With Alcohol or Other Drugs
Mixing lean with other substances raises the overdose risk. The FDA label warns that codeine with benzodiazepines or other depressants “may result in profound sedation, respiratory depression, coma, and death” [2].
The label also says to avoid alcohol. Alcohol slows breathing even more and raises the chance of a fatal overdose.
Sleep aids and other opioids are risky too. Mixing prescription cough syrup with them can cause dangerous respiratory depression. A teen may stop breathing.
Some teens who use lean also take pills from friends or social media. Pressed pills can hide fentanyl, which makes these dangerous drugs even riskier.
Signs of a Lean Overdose
A lean overdose is an opioid overdose, and knowing the signs can save a life. Watch for very slow breathing, gurgling or snoring sounds, blue lips, tiny pupils, and a person who will not wake up. If someone has slow breathing or has stopped breathing, call 911.
Give naloxone if you have it. If normal breathing has not returned after 2 to 3 minutes, give another dose with a new device. Follow the dispatcher’s instructions for rescue breathing or CPR. Use the side position if the person is unconscious but breathing normally. Stay until help arrives [3]. Naloxone reverses the opioid effects of codeine, but not promethazine. In 2023, the FDA approved Narcan as the first naloxone nasal spray sold without a prescription [4].
What the FDA Says About Codeine Cough Syrup
In January 2018, the FDA acted on prescription cough and cold medicines with codeine or hydrocodone [5]. It limited them to adults 18 and older.
The FDA labeling change also added to the boxed warning, the strongest warning on a drug label. It now names misuse, abuse, addiction, overdose, death, and slowed breathing. That notice also said a few states let some codeine cough medicines be sold over the counter. Teens may think store products are safe, too. That goes for opioid-like tianeptine products sold in some convenience stores.
The current label puts this codeine promethazine syrup in Schedule V, a class of controlled substances [2]. It also bars use in children younger than 12. The FDA set that limit in April 2017. Some people turn codeine into morphine very fast. In them, even normal doses have caused breathing problems that can kill. The label also warns the syrup may lead to more seizures in people who already have them.
Promethazine codeine products are not a normal teen prescription. A bottle in a teen’s room calls for a calm question.
Warning Signs of Lean Use in Teens
Lean use is hard to spot because the drink looks like soda. Look for behavioral patterns and changes in daily life.
Physical signs include nodding off, slurred speech, and slow reactions. Over time, you may see new friends, lost interest in sports, and secrecy about money. Daily use and needing more are warning signs of lean addiction.
At home, check for cough syrup missing from your shelves or a relative’s house. Look for purple stains in cups and piles of soda bottles. Hard candy wrappers and a pill bottle with someone else’s name are clues too.
In Utah, the 2025 SHARP survey found that 1.1 percent of 12th graders had ever misused prescription narcotics [6]. The report counts this in its “prescription drug abuse” measure.
What Parents Can Do
Lock up potentially dangerous cough syrup and opioids at home. Take unused medicine to a drug take-back site or follow a pharmacist’s disposal advice. Keep naloxone within reach. Then talk with your son calmly and ask what he knows, without blame.
Book a visit with your son’s doctor or an addiction medicine doctor. A full exam can show whether he has an opioid use disorder or other substance use disorders. It can also show what level of care he needs.
Care may be outpatient counseling. It may also include medication for opioid use disorder. Some teens need to stay in inpatient or residential care.
Counseling and recovery support are core parts of care. Counseling often uses CBT, a therapy that works on the thoughts behind actions.
If you also find pills, take them seriously. Counterfeit blue M30 tablets often contain fentanyl and can kill with one dose.
For free, private help at any hour, call the SAMHSA National Helpline at 1-800-662-4357. SAMHSA is the Substance Abuse and Mental Health Services Administration.
Lean Drink Frequently Asked Questions
Is Promethazine a Narcotic Drug?
Promethazine on its own is not a narcotic or an opioid. It is an antihistamine used for allergies, nausea, and motion sickness. But when it is mixed with codeine in one syrup, the law treats the mix as a controlled drug, since codeine can be addictive.
Can Narcan Reverse a Lean Overdose?
Narcan, a brand of naloxone, can reverse the codeine part of a lean overdose and may restore breathing. It does not reverse the sedation from promethazine. Call 911, give naloxone if you have it, and stay with the person until help arrives, even if he seems to wake up.
Is Promethazine Codeine Strong?
Promethazine codeine syrup is strong enough to cause dangerous breathing problems. The risk is higher in teens and when mixed with alcohol or other drugs. Codeine is less potent than oxycodone or fentanyl, but the dose in a lean drink may be unknown or poorly measured.
If you are worried about your son and lean, codeine, or other opioids, get guidance for your son’s next steps. Call our confidential admissions team. We can talk through what you see and how treatment for teen opioid use works.
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If you think someone is having an overdose, call 911. For a mental health crisis, call or text 988.
Sources
- Ware OD. Lean/Sizzurp Ingredients, Use, and Coping With Mental Health Symptoms. Substance Abuse: Research and Treatment (September 22, 2023). https://pmc.ncbi.nlm.nih.gov/articles/PMC10517614/
- U.S. National Library of Medicine, DailyMed. Promethazine HCl and Codeine Phosphate Oral Solution prescribing information. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=785c605e-1907-4fac-8b69-d504a2076f8e
- Centers for Disease Control and Prevention, NIOSH. Responding to a Suspected Opioid Overdose (2019). https://www.cdc.gov/niosh/publications/numbered/2019-127.html
- U.S. Food and Drug Administration. FDA Approves First Over-the-Counter Naloxone Nasal Spray (March 29, 2023). https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray
- U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA requires labeling changes for prescription opioid cough and cold medicines to limit their use to adults 18 years and older (January 11, 2018). https://www.fda.gov/files/drugs/published/Drug-Safety-Communication–Opioid-Cough-and-Cold-Meds.pdf
- Utah Department of Health and Human Services. Student Health and Risk Prevention 2025: SHARP Survey Results for State of Utah (2025). https://dsamh-training.utah.gov/_documents/SHARPreports/2025/State_of_Utah_Profile_Report.pdf
