Truth be told, I read my daughters texts. I don’t feel great about it but 7th-graders aren’t “oversharers” (with their parents) and I want to have an idea of what is going on. Her texts were my source of learning about the drug called Lean. It wasn’t at a conference or in one of my 4,000 medical magazines that seem to come daily; it was embedded in a text to a friend about what their respective schools were like. She mentioned there were lots of kids who use Juul and some who use the Lean drug. What? Huh? Am I the last to know this is a thing? What is the drug Lean??!!
I couldn’t wait for her to get home from school so I could ask more. In the meantime, I did some research.
What is the drug Lean?
“Lean” is also known as Purple Drank, Sizzurp, Purple Lean, or Dirty Sprite. The classic color of the drink is, not surprisingly, purple and it is nicknamed “Lean” because it literally makes you lean.
My daughter reported hearing a group of 6th-grade boys discussing “doing” Lean and how they mix it with Sprite. Lean is classically a mix of Sprite, prescription cough syrup, and a hard candy like Jolly Rancher.
Prescription cough syrups contain codeine, an opioid drug. They also can have an antihistamine, promethazine, that causes sedation and can impair motor functioning (hence causing the lean).
How common is the drug called Lean? 
There isn’t good information about how prevalent using “Lean” is since the ingredients aren’t too trackable. But if my 7th grader knows about it, I take that as a sign that we should all be aware. Here is a study on prevalence in China.
In 2011, the Department of Justice wrote a Drug-Alert Watch on the resurgence of Purple Drank. It writes about some history on Lean:
Used since the 1960s primarily in and around the Houston area, Purple Drank also has been prevalent in other areas of the south. The mixture enjoyed a revival in the 1990s. A 2007 music album and a song titled Purple Drank and other recordings and music videos by hip-hop and rap artists appeared to glamorize and promote the mixture.
Is the drug Lean safe?
Well, of course, it isn’t. But let me say more. Given the national opiate crises, we all know that taking opiates is dangerous and can lead to addiction, overdose, and death. It’s easy to imagine people who use lean don’t have a great idea of the amount of codeine they are ingesting since they are drinking a medicine that tastes like syrup, mixed with candy and soda. This puts them at higher risk of dangerous consequences.
Codeine:
Serious side effects of Codeine include slowed heartbeat, shallow breathing, blurred vision, agitation, and hallucinations. Read more from Medline about Codeine’s effects.
Promethazine:
Promethazine, a drug given for things like motion sickness, nausea and vomiting, or allergic reactions, is “anticholinergic”. When something is anticholinergic it has particular side effects that can be associated with it which increase with the amount taken. In medical school, we learn lots of mnemonics to remember side effects:
Blind as a bat (dilated pupils)
Dry as a bone (dry skin, mouth, eyes)
Red as a beet (flushing)
Mad as a hatter (delirium, confusion, agitation)
Hot as a hare (increased body temperature)
Here is more about promethazine side effects and overdose.
Celebrities spreading the word about the Lean drug:
Apparently, if I had read more celebrity news and not just medical journals I would have known about the Lean drug sooner. It’s sung about in rap lyrics and pictures of drinking out of a styrofoam cup (commonly the way to drink it. I don’t know why) are spread on social media.
The National Institute on Drug Abuse for Teens wrote a blog in 2013 about Lean:
In recent months, gossip magazines have reported on Justin Bieber’s erratic behavior, such as wearing a gas mask, fainting at a London concert, and traveling with a monkey. Mixed in with these reports is speculation about Bieber’s alleged use of a drug concoction called “Sizzurp.”
Bieber isn’t the only musician associated with the drink. Back in March and again at the beginning of May, rapper Lil Wayne was admitted to the hospital with seizures, allegedly from his use of Sizzurp (although he denied it)
The Lean drug
Well, there you go. Here’s my summary of a drug that I didn’t know existed prior to my daughter…ahem… “informing” me. Obviously, kids are using it (along with adults) and it is important for us all to know what to watch out for.
Someone, please tell me you also didn’t know about the Lean drug so I can feel I’m not the only one surprised! If you knew, how did you hear about it and what have you heard?
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Great info here! Very important to know what kids are up to and the social trends in that population.
It’s hard to keep up with them! Glad you found it helpful
I’ve never heard of it, but will be asking my 8th grader about it. Thanks for the info!
I’m glad I’m not the only one that hadn’t heard of it! I was really surprised once I started researching it.
An informative and important article; I know this information will help parents. Apparently I was asleep in 2013; I have never heard of Lean or any of the other terms you mentioned. Frankly, I am happy I don’t have kids. Not having any kids, means empathy only goes so far; but I feel for parents who are dealing with kids that have a substance abuse concern. I hope that your work with help enlighten those parents. Thank you Melissa!
Everything old is new again. Mixing cough syrup and soft drinks has been around forever, the names get better though. “RCR” circa 1970-71 was Romilar (Dextromethorphan) and RC Cola Romilar was removed from OTC in 1973. Need not ask me how I know this.
I didn’t know about this. Thanks for the information.
Thank you so much for informing us, Dr. Welby! I’m so grateful for your insight. I’d never heard of it either!
I hadn’t heard about this drugs/drug concoction—thanks for spreading the word about this! Frankly, it makes me wonder how many other drug concoctions are running around in our schools—scary to even think about, but so very important to know.
As always, thank you for your thoughtful comments, Kevin.
I won’t ask Howard! I’m going to look this up though- interesting history lesson for me!
That is a really good point. I’m sure there is a lot we don’t know! Although, when I asked the school they were very aware of what it was.
Your welcome Rachel!
Your welcome Sarah! It’s always good to know what’s out there…
As an RN I’m always thankful for sudstance abuse info. To guide me at work. I have been crazy for the past few years trying to get doc’s to see the abuse of gabapentin in young adults. And if they hadnt acknowledge d that how would they ever get this Lean mix?? Thanks
I agree, as a whole, we were slow to acknowledge the abuse of gabapentin. Thanks for your comment
I wasn’t aware that gabapentin was a drug being abused. I take 3600 mg a day for nerve damage and have never felt “high”. What do they get out of taking i
Many people take gabapentin without feeling “high” or abusing it. It is a helpful medication for different conditions including nerve damage as you described. For those who may be taking it to feel “high”, they may describe feelings of euphoria, relaxation, and calm. I think the effects when abused vary- I’ve had some describe it as similar to effects of marijuana, and others say similar to an opiate. It can also “enhance” the high when combined with other drugs.
There was a song in 2000 with the lyrics “sippin’ on some siz-erp” that I remember from college. Catchy tune. Thanks for letting us know about the “rebranding” as Lean
Another good reason to remind all our patients to dispense of unused medication, especially opiates. It’s a point that gets stressed with oxy but less so with cough syrups.
Absolutely! Dispose of unused medicines! If you need it again it can be prescribed and the risks are too great to leave them hanging around- especially medications that can be abused
Yes, it has re-branded! I apparently missed siz-erp and the celebrity drama around overuse of it at the time.
High school senior here-from the Houston area, you’re making a much bigger deal about lean than you have to. The amount of codeine in lean is minimal the not nearly enough the amount it would take to hospitalize you like what happened to celebrities and most don’t use it as often. Is it a drug? yes but it’s not as bad compared to marijuana or smoking. Also, reading her text won’t make her want to talk to you. Take it from me. My mom invaded my privacy so much growing up & it made me isolate her from my life even more. Just trying to be helpful
Thank you for your comments. You are right that there is a fine line to reading texts of your children. It likely depends on the ages and personalities of the children, the relationship that is already present between parent and child, and also the awareness that the parent may read the texts periodically. It certainly can drive people apart as you describe but there is also no one right or wrong answer. As for lean, I am sure the amount of codeine varies but I would have to disagree that it is “safer.” Regardless, it is important for people to be aware that it is something some kids are experimenting with at school.