According to the National Institute on Drug Abuse (NIDA), lean, also known as syrup, purple drank, and sizzurp, is a mix of soda, Jolly Ranchers candy, and cough syrup. The cough syrup component of lean is typically a codeine-based cough syrup.
Codeine (3-methylmorphine) is a narcotic drug in the same class of drugs like heroin, morphine, Vicodin, OxyContin, etc. Codeine has a number of medicinal uses but is most often used as a as a cough suppressant and pain reliever.
The United States Drug Enforcement Administration (DEA) categorizes medicines that contain less than 90 mg of codeine as Schedule III controlled substances, and medicines that have more than 90 mg of codeine are classified as Schedule II. This indicates that the potential abuse effects of codeine are dose-related and that the drug can only be legally obtained with a prescription from a physician. Obviously, individuals who use it for recreational purposes are using it in contrast to its prescribed uses, and they most often obtain the drug illegally. The formulation of lean has received some publicity in the past as a drug used by certain celebrities, like pop singer Justin Bieber and rapper Lil Wayne.
When taken at prescribed doses, codeine is safe; however, abuse has serious potential consequences, including the development of physical dependence if the drug is abused habitually. The popularity of lean with celebrities may give the impression that the drug is relatively safe, and younger people often tend to think that drugs that can be acquired with a prescription are safe to use in any manner, but this is not the case.
Withdrawal from Codeine (Lean)
Codeine has a very similar mechanism of action to other opiate or narcotic drugs. These drugs readily attach to specific neurons in the brain. These neurons are specialized for neurotransmitters that are often referred to collectively as endogenous opiates because they relieve the subjective perception of pain, stress, exertion, anxiety, etc.
When opiate drugs are used on a regular basis for a significant length of time (typically at least 4-6 weeks), there is a chance that the individual will develop physical dependence on them. Physical dependence consists of the syndromes of tolerance and withdrawal. Tolerance to opiate drugs develops extremely quickly, as individuals find they need more of the drug to get the same effects they once got at lower doses. Not long after tolerance is established, individuals may find that they develop withdrawal symptoms when they stop using the drug. Both the syndromes of tolerance and withdrawal will strengthen as an individual continues to take the drug.
People who have developed physical dependence on codeine will often display varied symptoms of withdrawal. These typically include:
- Symptoms that mimic the flu or common cold: These will often include a runny nose, sneezing, stomach cramps, nausea, vomiting, diarrhea, fever, chills, headache, sweating, muscle aches, jitteriness, shakiness, etc.
- Autonomic nervous system symptoms: These can include dilated pupils, irregular heartbeat, irregular breathing, and changes in blood pressure.
- Psychological symptoms: These most often include issues with anxiety, mood swings, confusion, concentration, insomnia, poor appetite, and severe cravings to use codeine. There are very rare cases of seizures that occur in individuals who are withdrawing from an opiate like codeine, but often, the seizures are associated with some other drug of abuse, such as an individual who abuses codeine and alcohol together or codeine and a powerful stimulant medication/drug.
The symptoms of withdrawal can be rapidly diminished by simply taking the drug. This is why individuals often relapse very quickly during withdrawal. Continuing to take the drug to avoid the negative effects of withdrawal strengthens the behavior of using the drug and makes it even more difficult to quit.
The withdrawal symptoms associated with opiate drugs like codeine are not generally considered to be potentially physically dangerous, but they are quite uncomfortable. Nonetheless, individuals can suffer potentially dangerous complications associated with dehydration as a result of vomiting or diarrhea, making poor decisions due to cognitive and psychological issues associated with withdrawal, and overdosing when attempting to use codeine to stop the symptoms of withdrawal.
Overdose on any opiate drug is a serious and potentially life-threatening situation. Individuals who overdose on any opiate drug need immediate medical attention.
Like the symptoms of withdrawal from codeine, the timeline for withdrawal can be quite variable. A general timeline follows:
- The syndrome begins rather quickly after the person has stopped using lean. Because codeine has a short half-life, individuals may begin to experience issues with nausea, mild headaches, aches and pains, shakiness, and cravings within 12 hours after they have stopped using the drug. The majority of individuals who have been chronically abusing codeine will begin to experience some level of withdrawal symptoms within 24 hours after they have stop using it. Individuals can experience any number of the symptoms listed above during the early stages of withdrawal.
- After the onset of withdrawal symptoms, most individuals will reach a peak in the severity of their symptoms within 3-5 days and then the intensity of the symptoms will begin to slowly dissipate. As the symptoms begin to reach their peak, individuals may develop any number of the symptoms listed above. Cravings are typically present throughout the withdrawal process.
- Within 7-10 days, most individuals will have run the course of the most severe and troublesome withdrawal symptoms from codeine. There may still be some minor issues with mood swings, mild nausea, mild headaches, cravings, etc., a week after discontinuation, but in most cases, these will be relatively minor.
- Even though the syndrome has never received sufficient research support to identify it as a formal withdrawal syndrome, a number of sources still refer to post-acute withdrawal syndrome. This syndrome sometimes continues after the formal period of withdrawal is complete. It can reputedly last for weeks, months, and even years in some cases and is primarily associated with emotional or psychological symptoms, such as cravings, issues with mood, motivation, etc. This syndrome is not recognized as a formal manifestation of withdrawal, and it most likely represents other psychological factors that occur in those with other co-occurring psychological disorders or subclinical conditions, such as longstanding issues with motivation, mild mood swings, etc.
Treatment to Assist with Detox from Lean
Even though the withdrawal syndrome associated with opiate drugs like codeine is not generally considered dangerous, the preferred approach for withdrawal is to consult with a physician and be enrolled in a formal withdrawal management program. This program typically involves the physician administering some type of opiate replacement medication to eliminate any of the potential withdrawal symptoms that may occur. The most commonly used opiate replacement medications are methadone, buprenorphine, and Suboxone (buprenorphine and naloxone).
Medications such as methadone and buprenorphine are partial opioid agonist drugs that are in the same class as opiate drugs but do not have the full opiate drug effect. The medication fools the central nervous system into thinking that the person is still taking their opiate drug of choice, such as lean. This help the individual get through the withdrawal process with very mild symptoms or, in some cases, no symptoms at all.
Typically, a physician administers the opioid replacement drug in an initial dose that results in the person not experiencing any significant withdrawal symptoms. Then, over time, the physician slowly reduces the dosage of the drug according to the person’s response. Eventually, the dose will be relatively small, and the medication can be discontinued. This process results in the individual going through the withdrawal process without experiencing any significant discomfort.
Other medications may also be used, depending on the situation and the symptoms or needs of the individual. Withdrawal management programs typically take longer than “cold-turkey” detox; however, the potential for serious complications, issues with discomfort, and relapse are significantly reduced.
Many individuals are under the mistaken impression that once they get through the withdrawal process, they are “cured.” There is no cure for addiction, and completing detox is only the first step in the treatment process.
As it turns out, people who simply detox from lean and do not engage in any follow-up treatment for their substance use disorder relapse at rates that approach 100 percent. It is well known that the most effective approach to treating any substance use disorder, including an opiate use disorder as a result of codeine abuse, is to become involved in substance use disorder therapy and a formal substance use disorder treatment program that includes elements of social support, treatment of co-occurring disorders, psychoeducation, and relapse prevention. Even individuals who participate in complete recovery programs may have significant issues with relapse; however, they relapse at far lower rates than people not involved in formal treatment, and they are far better prepared to deal with relapse issues.
The foundation of any formal substance use disorder treatment program is substance use disorder therapy. This treatment is delivered by a trained and licensed therapist with experience treating individuals with substance use disorders. Most often, the type of therapy used in some form of Cognitive Behavioral Therapy; however, any form of therapy that is designed to treat substance use disorders can be productive. Therapy can be delivered on an individual basis, in groups with other individuals in recovery, or in a combination of individual and group sessions.
In conclusion, detoxing from lean is best accomplished in a professional medical setting. While detox is a vital step in the process, it should be followed by comprehensive substance abuse treatment.