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.
“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).
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.
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.
Serious side effects of Codeine include slowed heartbeat, shallow breathing, blurred vision, agitation, and hallucinations. Read more from Medline about Codeine’s effects.
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. In medical school, we learn lots of mnemonics to remember side effects and this one I will never forget:
“Can’t pee, can’t see, can’t climb a tree”
What this means is that these side effects (which obviously increase with the amount taken) include blurry vision, inability to urinate (hence Lean’s association with urinary tract infections), and unsteadiness.
I found this mnemonic about anticholinergic side effects a little boring but remember it nonetheless:
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.
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)
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?
A version of this article first appeared here.
Dr. Melissa Welby is a psychiatrist that participates in people’s process of discovery, empowerment, and search for satisfaction and happiness. She treats a variety of illnesses including depression, anxiety & panic attacks, adult ADHD (Attention Deficit / Hyperactivity Disorders), bipolar disorder, OCD (Obsessive-Compulsive Disorder) and borderline personality disorder. She is also the current president of the Connecticut Psychiatric Association.She completed her Internship & Residency at Cambridge Hospital, affiliate of Harvard Medical School, 2000 to 2004. Dr. Melissa Welby is Board Certified in General Psychiatry by the American Board of Psychiatry and Neurology, 2005 to present.