Lean

Codeine; Promethazine

Purple Drank, Sizzurp, Drank, Syrup, Barre

Psychoactive Class

Chemical Class

Phenothiazine antihistamine Morphinan (opioid)

Lean is a polysubstance recreational drink combining prescription cough syrup containing codeine (an opioid) and promethazine (an antihistamine) with soft drinks and hard candy.¹² Originating in Houston in the 1960s, it became culturally prominent through association with hip hop music, particularly in the Southern United States.²³ Lean carries significant risks including addiction, respiratory depression, and overdose.⁴ It is especially dangerous when combined with alcohol or other CNS depressants.⁴⁵

Dosage & Duration

Dosage

Moderate100-150 mg

Doses refer to the codeine content of codeine-promethazine cough syrup; commonly cited promethazine ranges are 25-75 mg. A 50 ml syrup bottle containing 10 mg codeine and 6.25 mg promethazine per 5 ml provides 100 mg codeine and 62.5 mg promethazine in total. Codeine causes respiratory depression and promethazine adds central nervous system depression, so higher doses carry a risk of respiratory or cardiac arrest; combining with alcohol or other depressants greatly increases this risk. The preparation is addictive and prone to overdose, and discontinuation after regular use can produce withdrawal.

Duration

Onset30-30 minutes

Total6-6 hours

Subjective Effects

The experience is generally mild and sedating rather than intense, taking the form of a gentle head inebriation with a sense of calm comfort and dissolved anxiety. Onset is noticeable within the first fifteen minutes as a light head inebriation, deepening over the following hours into a dreamier, detached serenity with a slight sense of uplift before fading into a calm background aura. Rather than a pronounced high, it is described as a sustained elevation and a mildly euphoric comfort bubble, with increasing sleepiness as it wears off and tiredness dominating later in the day. Motor-skill impairment and a dissociative feeling from the body accompany the sedation.

Physical

Relaxation, sedation, drowsiness, and lethargy dominate the body, with impaired motor skills and difficulty standing upright. Facial flushing, cold hands, and a faint hint of numbness were also reported.

Sedation

Muscle relaxation

Cognitive

The headspace is heady and mildly drifting, with anxieties dissolving into a mellow, pleasing calm that stops short of frank euphoria; at higher intensity it becomes a numbed, detached distance from the surroundings.

Emotional

Reagent Testing

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Pharmacology

Pharmacodynamics

Lean produces its effects through the combined action of its two primary active ingredients. Codeine, a morphinan opioid, acts as a prodrug that is metabolized to morphine⁶⁷, which then activates μ-opioid receptors to produce analgesia, euphoria, and respiratory depression⁷⁸. Promethazine, a phenothiazine antihistamine, acts as a central nervous system depressant through histamine H1 receptor antagonism and contributes additional sedative effects⁶. The combination appears to produce synergistic CNS depression, with promethazine potentially enhancing the euphoric effects of codeine while simultaneously increasing respiratory depression risk through its own depressant properties⁹.

Pharmacokinetics

Codeine undergoes hepatic metabolism, with a portion converted to morphine via CYP2D6 O-demethylation, which is responsible for its opioid effects⁶⁷. The rate of this conversion varies significantly between individuals due to CYP2D6 genetic polymorphisms⁷. Promethazine is also hepatically metabolized⁶. When consumed orally as lean, both compounds are absorbed through the gastrointestinal tract⁶.

Tolerance

Cross Tolerance

Opioids (morphine, heroin, oxycodone, hydrocodone, and other μ-opioid receptor agonists)¹⁰

Harm Potential

Addiction & Dependence

Psychological

High

Lean carries significant psychological addiction potential due to the euphoric effects of codeine combined with the sedating properties of promethazine.¹¹ Users frequently develop compulsive use patterns, with the drink's cultural normalization potentially masking the severity of dependence.¹¹

Physical

High

Physical dependence develops with regular use due to the opioid component.¹² Withdrawal has been described as feeling like 'death in your stomach' and discontinuing regular usage brings about significant withdrawal symptoms that make cessation difficult.

Toxicity

Respiratory System

Respiratory depression is the primary mechanism of acute toxicity and can occur at high doses or when combined with other depressants; this effect is dose-related and represents the main pathway to fatal overdose.¹³

Cardiovascular

Cardiac complications including cardiac arrest have been reported as serious outcomes of lean use, with at least one documented case of fatal heart attack in a chronic user.⁹

Hepatic

Liver problems have been reported in chronic heavy users of lean, potentially contributing to fatal outcomes in cases of prolonged addiction.¹⁴

Renal

Kidney problems have been reported in chronic heavy users, potentially developing alongside hepatic complications in cases of prolonged addiction.¹⁴

Seizure Risk

Lean does not appear to directly cause seizures but increases their likelihood in susceptible individuals.¹² At least one documented fatality involved a seizure in a chronic user who had developed organ complications from prolonged use.¹⁵

History & Culture

Origins in Houston

Lean is thought to have originated in Houston during the 1960s, when blues musicians in the city's Fifth Ward, Third Ward, and South Park neighborhoods began mixing Robitussin cough syrup with beer.¹⁶ When wine coolers entered the market, they replaced beer as the…

Legality

By Country

United StatesSchedule V (combination product) / Schedule II-III (components)²⁸²⁹

Codeine-promethazine combination cough syrups are classified as Schedule V controlled substances when containing limited quantities of codeine.²⁸³⁰ However, codeine itself is Schedule II,²⁹ and products with higher codeine concentrations may be Schedule III.³¹ Prescription required; regulations vary by state regarding pharmacy dispensing requirements.

United KingdomPrescription Only Medicine / Class B (codeine)²⁶

Codeine is a Class B controlled substance under the Misuse of Drugs Act 1971.²⁶ Promethazine-codeine combination products require prescription. Low-dose codeine preparations (up to 12.8mg per dose unit) are available over-the-counter only in combination with other active ingredients,²⁷ but pure codeine and higher-strength preparations are prescription-only.

References

Source Pages

Citations

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Lean

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