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Lean (“Purple Drank”) Addiction and Treatment

Lean (aka “Purple Drank,” “Sizzurp,” “Syrup,” and “Juice”) has been in circulation since the 60s in Houston, Texas, gaining popularity in the early 90s underground hip-hop scene. The drink blend was created with the promise of relaxation, euphoria, and overall good time. Lean is one of many street names for a drink comprised of fruity soft drinks, hard fruit candy, codeine, and promethazine. So how did Lean get so popular in our current mainstream? And just how dangerous can this fizzy purple drink be?

Symptoms of Lean Use

Symptoms of Lean use are similar to other forms of opioid abuse. In striking contrast to other opioid addictions, however, Lean abuse seems to be acclaimed and worthy of sharing on social media outlets such as Instagram, Snapchat, and Twitter.

While the drink seems harmless to the naked eye, people who use Lean experience a variety of adverse symptoms, including:

Narrow pupils and limited response to lights
Droopy eyes and rapid, uncontrolled eye movement
Sore throat and gravelly voice
Slurred speech and cognitive impairment
Sleepiness
Diminished heart rate
Loss of coordination and balance
Pale skin
Constipation and urinary tract infections
Dental complications
Poor hygiene over time

Codeine is responsible for the calming euphoria which users intend to feel while drinking Lean. Many of the adverse reactions associated with Lean are directly related to the inclusion of codeine in the mix. Many users seem to disregard the fact that codeine, although prescribed, is still an opiate.

Codeine: an Opiate

Codeine is an opiate which is prescribed to patients for mild to moderate pain and can be used as a cough suppressant in more serious bronchial infections. When used as prescribed, the effects of codeine are mild compared to more potent opiates on the market. When used in excess, the effects of codeine are similar to that of morphine or heroin.

Taken alone, the effects of codeine use include:

Euphoria
Dizziness
Blurred vision
Cognitive impairment
Visual and auditory hallucinations
Seizures

Codeine can become addictive as easily as other opioids. Over time, consumption of Lean can cause users to grow tolerant of the drug, thus requiring more codeine to experience the same effects. Users will also endure more intense withdrawal symptoms over time. This could lead to “maintenance use,” or simply consuming the drink to prevent withdrawal, and never achieving the desired effect.

In the past, opioids were a staple in medicinal pain management. Federal and state regulations have begun placing limitations on prescription opioids for pain management in an effort to combat the epidemic of opioid addiction in America.

How Long Does Lean Stay in the Body?

The effects of Lean can last as long as it takes for your body to metabolize the concoction. The half-life of codeine—the time it takes for the body to metabolize the drug in half—is approximately 2.5 to 4 hours based on normal metabolic activity. Since Lean is taken orally, the kidneys will do most of the work to flush the drug from the user’s body.

Certain factors influence the time it takes for Lean to completely leave the body, including:

Age
Weight
Gender
Overall health
Other opiates/opioids consumed
Amount of Lean consumed

In the event of a drug test, a urinalysis will detect codeine in a person’s system for an average of thirty-six hours after use. Saliva tests can detect codeine as long as two days after use, and blood tests show codeine for about twenty-four hours following use. Hair follicles hold codeine for the longest period and may be detected there up to ninety days following use.

Lean Overdose

Opioid overdose and death are a public health crisis in the US. The Center for Disease Control and Prevention (CDC) reports a steady incline of opioid overdose deaths from 8,048 in 1999 to 70,237 in 2017. This is due in part to carelessness of prescribers and the consequent upward trend of opioid addiction. Lean is likely to cause overdose because it is often consumed in large doses.

Signs of Lean overdose include:

Slow, labored, shallow breath or loss of breathing
Cold and clammy skin
Confusion
Body weakness
Loss of consciousness
Itching or flushing of the skin
Blue fingertips and/or lips
Coma
Muscle spasm
Nausea and vomiting
Stomach and intestine spasms
Shock
Severe pneumonia
Brain damage
Death

In the event of overdose, it’s important to call 911 and have information ready for medical staff. Disclosing the ingredients, amount (if known), and time consumed can help physicians provide life-saving care. An electrocardiogram (ECG), chest x-ray, IV fluids, and activated charcoal (or opioid-reversing Naloxone) will be administered. Additional breathing support and other stabilizing procedures may be necessary.

Lean in the Media

Lean is among the most glamorized forms of opioid abuse. This is due in part to its integration into mainstream imagery, whereby a purple drink is glorified by influential people. With opioid misuse doubling over the past ten years, it’s pertinent that the public recognizes Lean’s potential for becoming normalized, thus adding to the opioid epidemic the US is currently facing.

Some instances of famous people who have fallen victim to the drug include:

Rap producer DJ Screw (d. 2000) and rapper Big Hawk (d. 2006), both of Houston, have died as a result of codeine overdose.
JaMarcus Russel, a former quarterback for the Oakland Raiders, was fired from the NFL in 2005 after he was purportedly “drowsy and weak” too often. He was arrested soon after his dismissal for possession of cough syrup containing codeine.
Terrance Kiel was fired from the San Diego Chargers as a result of his arrest for distributing codeine in 2006. He died in 2008 in a car crash following a Fourth of July party.
Johnny Jolly, former defensive tackle for the Green Bay Packers, was arrested after police found codeine and discarded styrofoam cups (indicating Lean consumption) in his possession.

In a two-week 2016 study by JMIR Public Health and Surveillance, over 50 percent of hashtags on Instagram which included #codeine accompanied an image of Lean or contained additional tags which indicated Lean use. The openness of Lean use warrants a further look into how the public perceives the dangers involved in Lean abuse.

Treatment for Lean Addiction

Treatment for Lean addiction is similar to treatment for other opioid addictions. There will be a period of withdrawal, detox, and eventual behavioral therapies. Withdrawal from opioids can be particularly uncomfortable for an average of seventy-two hours and will then slowly begin to taper after peak withdrawal. Discomfort can be lessened with the use of medically monitored and medicated withdrawal.

Symptoms of opioid withdrawal include:

Nausea
Muscle cramps
Depression and agitation
Anxiety
Headache, nausea, and vomiting
Exhaustion

The effects of opiate withdrawal are perceived by patients as the hard part. Once the physical addiction is eradicated, however, behavioral health becomes the top priority to prepare for sobriety after rehab. Depending on the level of addiction, patients may undergo short-term (fifteen to thirty days) or long-term (sixty to ninety days) for treatment. To aid in recovery, additional outpatient therapies and sober living housing may be utilized.

Lean Addiction Can Be Treated.

Lean addiction may seem benign compared to its more powerful opioid counterparts; however, the risk is just as high for overdose death. If you or a loved one is struggling with Lean addiction, now is the time to get help. Our friendly staff is here to help you find answers and resources to help you on the road to recovery. Don’t hesitate—contact us today.

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