Lean is one of the slang names for a concoction of prescription cough medication, soda (most often Sprite), and candy that is used by mostly younger individuals to achieve the psychoactive effects associated with the opiate drug codeine, one of the most common drugs in prescription cough medicines. Codeine (3methylmorphine) is processed from the poppy plant. It is an opiate or narcotic medication in the same class of drugs as morphine, heroin, hydrocodone, etc.

Codeine is a controlled substance, and its distribution is monitored according to the controlled substances listed by the United States Drug Enforcement Administration (DEA). The status of codeine depends on the amount of the drug in the specific medication, such that products that contain over 90 mg of codeine are classified as Schedule II controlled substances, whereas products that contain less than 90 mg of codeine are classified in the Schedule III category. The medicinal uses of codeine include cough suppression and as an analgesic to control pain.

Because the drug is legal (with a prescription), many people are under the mistaken impression that it is safe to use for recreational purposes. However, its controlled substance status indicates that the drug is not safe for use unless the person is using it under the supervision of a physician and according to its prescribed instructions. Opiate drugs like codeine have useful medical applications, but they can also be extremely dangerous when abused.

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Effects of Abusing Prescription Cough Medicines

The National Institute on Drug Abuse (NIDA) reports that the use of lean (sometimes referred to as syrup, purple syrup, or purple drank) is problematic for younger individuals, mostly people who are under the age of 25. NIDA reports that the abuse of this concoction most often includes individuals drinking large amounts of the drug mixed with soda and other sweeteners. Many of these prescription cough medications contain both codeine for cough suppression and promethazine as a decongestant. The cough syrup is intended for short-term use and to be taken in specified amounts at specific time intervals. Long-term abuse of these drugs can result in some potentially dangerous effects.

Physical Dependence and the Development of an Opiate Use Disorder

One of the most salient long-term effects of abusing codeine products like lean is the potential to develop physical dependence on codeine and an opiate use disorder.

The development of physical dependence on a drug that is being continually used for medical reasons is typically not considered to be problematic because the amount of the drug being used by the person is monitored by a physician, and the effects of the drug use are also monitored. The physician can work with the person to control their use of the drug and address any side effects.

Individuals who abuse drugs and develop physical dependence on them represent a different problem. Individuals who abuse drugs will continue to take increasing amounts of the drug to achieve the desired psychoactive effects, and the development of tolerance accelerates this process. When significant tolerance develops, these individuals may be taking a large amount of the drug, and this obviously sets up a potentially dangerous situation. Individuals can become prone to overdose or experience significant withdrawal symptoms when they cannot get enough of the drug.

Physical dependence can occur as a result of the chronic use of codeine, whether the individual uses it under the supervision of a physician or abuses it.

The withdrawal syndrome associated with codeine is not considered to be potentially fatal, but individuals undergoing withdrawal can become desperate, distraught, and be prone to overdose or to engage in impulsive behaviors that can endanger them. In addition, individuals who become very nauseous, vomit, and experience diarrhea can become severely dehydrated, which can also be extremely dangerous.

According to the diagnostic criteria put forth by the American Psychiatric Association (APA), individuals who abuse lean (codeine) would be diagnosed with an opiate use disorder. By definition, these individuals have trouble controlling their use of the drug, are suffering serious negative consequences associated with its use, and are experiencing significant stress and dysfunction associated with their drug use. The diagnosis of a substance use disorder represents a severe form of a mental disorder, and individuals who are diagnosed with substance use disorders often have other co-occurring mental health disorders, such as anxiety disorders, major depressive disorder, bipolar disorder, eating disorders, etc.

Long-term effects of having any form of mental disorder can include:

Increased probability to develop a serious disease or physical condition
Increased risk of early mortality
Significant negative effects on personal relationships (see below)
Significant negative effects on personal and professional goals (see below)
Significant problems with finances
Increased probability to become involved with legal entanglements
Increased potential for a severe financial burden that may be long-term
The need for long-term treatment and restrictions on one’s lifestyle

Potential Long-Term Physical Effects

Codeine is a central nervous system depressant drug, meaning that it slows the functioning of the neurons in the brain and spinal cord. Chronic abuse of lean can result in some significant ramifications to physical health that can include:

Complications associated with chronic respiratory suppression, including increased potential to develop lung problems or respiratory diseases
Cardiovascular effects that can include problems with cardiac functioning, blood pressure, and an increased potential to suffer a heart attack or stroke
Damage to the liver
Kidney damage
Potential brain damage due to chronic hypoxia (decreased oxygen delivery) because of decreased respiration
Brain damage, including numerous cognitive and psychological effects like problems with memory, attention, judgment, and the development of emotional problems such as chronic depression, anxiety, etc.
Increased risk to become the victim of an accident or crime while under the influence of lean

Long-Term Behavioral Effects

Complications associated with the long-term abuse of lean are not limited to formal diagnoses or physical effects. Individuals who abuse prescription medications may suffer numerous ramifications to their behavior. According to the American Society of Addiction Medicine, APA, and NIDA, more serious potential ramifications associated with the abuse of an opiate drug like codeine over the long-term can include:

A significant loss of the ability to experience pleasure in things that the person once found interesting or pleasurable
Isolation from friends and/or family
Confusion, irrational behavior, and/or criminal behaviors to obtain money for lean
Neglecting personal hygiene or grooming
Increased potential to experience or engage in abuse in personal relationships (physical, verbal, emotional, or sexual abuse)
Isolation or becoming ostracized from family members and friends
Significant issues with resentment, guilt, and strife with important friends or family members
An inability to reach education or occupational goals
Loss of job
Significant financial issues associated with abuse and/or recovery

Avoiding Long-Term Issues Associated with Abusing Lean

The obvious method of avoiding potential detrimental long-term issues associated with lean abuse is not to use the mixture in the first place. However, for some individuals, the time to make that choice has already come and gone. The best alternative for these individuals is to seek professional help immediately. According to reliable sources, such as APA and NIDA, attempts by individuals to handle their substance abuse issues on their own is fraught with failure in nearly all cases. Instead, these individuals require professional assistance, support from family and friends, and diligence to stick to a long-term program of recovery.

For many individuals, the initial step is to consult with a physician, become involved in a physician-assisted withdrawal management program (a medical detox program), and then develop the foundation for a long-term care program. Medical management of withdrawal and other issues is extremely important to ensure a strong beginning in recovery from an opiate use disorder; however, the cornerstone for recovery is substance use disorder therapy. The use of adjunctive treatments, such as social support group participation (peer support groups like 12-Step groups) and other interventions, can increase the chances of long-term success.

Long-Term Effects of Lean