Sizzurp (Purple Drank or Lean): Definition, Key Ingredients, Health Effects, Addiction Risks

Sizzurp, also known as Purple Drank or Lean, is a recreational drink made from a combination of codeine-based cough syrup, promethazine, and a sweetened beverage, such as soda or candy. According to the National Institute on Drug Abuse (NIDA), sizzurp use is widespread. Approximately 3.1% of high school students reported misuse of prescription cough syrup in the past year, and it is notable in areas like New Hampshire​.

The key ingredients of sizzurp are codeine-based cough syrup, promethazine, and a sweetened beverage like soda or candy. Codeine, an opioid, provides sedative and euphoric effects, while promethazine, an antihistamine, enhances these effects, creating a highly potent and dangerous combination.​

The health effects of sizzurp include sedation, slowed breathing, dizziness, and impaired coordination due to the combined effects of codeine and promethazine on the central nervous system. Long-term use leads to respiratory depression, liver damage, cognitive impairments, and increased risk of overdose, as highlighted by the Substance Abuse and Mental Health Services Administration (SAMHSA)​.

Sizzurp carries significant addiction risks due to the opioid properties of codeine and the sedative effects of promethazine, leading to both physical and psychological dependence. According to the Centers for Disease Control and Prevention (CDC), opioid misuse, including codeine, contributes to over 70,000 overdose deaths annually in the United States​​.

What is Sizzurp?

Sizzurp, also known as “purple drank,” is a recreational beverage made by mixing prescription-strength cough syrup containing codeine and promethazine with soda and, in some cases, candy for added flavor. 

 A study analyzing data from the National Survey on Drug Use and Health (NSDUH) found that lean use was most prevalent among teenagers and young adults aged 13 to 21, accounting for 66% of users. 

The primary active ingredients, codeine (an opioid) and promethazine (an antihistamine) produce a sedative and euphoric effect, making it popular among users seeking relaxation or a “high.” 

According to the National Institute on Drug Abuse (NIDA), sizzurp is highly addictive and poses serious health risks, including respiratory depression, organ damage, and potential overdose.​

What Are the Key Ingredients in Sizzurp?

The key ingredients in sizzurp are codeine, promethazine, and a flavored drink or candy. Codeine is an opioid that provides sedative and pain-relieving effects, while promethazine is an antihistamine that enhances sedation, making the combination highly potent and prone to misuse​.

The key ingredients in sizzurp include:

• Codeine (Cough Syrup): Codeine is an opioid present in prescription cough syrups, known for its ability to suppress coughing and relieve pain by acting on the central nervous system. As a recreational drug, codeine produces euphoria and sedation, making it a primary driver of sizzurp misuse. According to a study by Ware et al. titled Codeine and Promethazine: Exploratory Study on Lean, published in PLOS ONE (2024), codeine is widely recognized for its high abuse potential​.
• Promethazine (Cough Syrup Additive): Promethazine, an antihistamine, is included in the formulation to treat nausea and allergies while enhancing the sedative effects of codeine. However, its combination with codeine leads to profound respiratory depression, making the mix highly dangerous. This combination is associated with a high risk of overdose due to compounded sedative effects​.
• Soda: Sweetened sodas are used to dilute the bitter taste of the cough syrup, making the mixture more palatable. This added sweetness disguises the risks of the drink, especially among young recreational users​.
• Candy: Hard candies, such as Jolly Ranchers, are added to enhance flavor, making the concoction more appealing. This masking effect further contributes to the popularity of sizzurp as a recreational drug, particularly in social and cultural contexts, as cited in Purple or Pink: Time to Rethink the Availability of Promethazine, published in Hofstra Law Review (2023)​.

What Makes Codeine and Promethazine a Risky Combination? 

The things that make codeine and promethazine a risky combination are their ability to enhance each other’s sedative effects, leading to respiratory depression and a heightened risk of overdose. 

Codeine, an opioid, suppresses pain and slows brain activity in the central nervous system. When combined with promethazine, an antihistamine with strong sedative properties, the effects on the central nervous system are compounded, severely impairing respiratory function. 

According to Ware et al.’s study published in PLOS ONE (2024), 74.5% of individuals who used sizzurp reported codeine consumption, while 31.7% included promethazine as a secondary component.​

The Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that opioids and sedatives significantly increase the risk of respiratory depression, particularly when co-administered. This is because both substances inhibit the brain’s respiratory control centers, making users unable to respond to declining oxygen levels. 

The synergistic effect between codeine and promethazine makes sizzurp one of the most dangerous recreational drugs when misused​.

What Are the Street Names of Sizzurp?

The street names of Sizzurp are Purple Drank, Lean, Syrup, and Barre. These names reflect its appearance, ingredients, and cultural references, making it popular in music and recreational use​.

The street names of Sizzurp are explained below:

• Purple Drank: This name originates from the purple color of the mixture, primarily due to the presence of codeine-based cough syrup. It is one of the most widely recognized slang terms, particularly popularized through music and media culture​.
• Lean: The term “Lean” refers to the physical effect the drink has on users, causing them to feel sluggish and “lean” due to its sedative properties. This term has become synonymous with recreational use of the concoction, particularly in hip-hop culture​.
• Dirty Sprite: Inspired by the common practice of mixing sizzurp with sodas like Sprite, this term highlights its appealing yet deceptive nature. As reported in Purple or Pink: Time to Rethink the Availability of Promethazine, published in Hofstra Law Review (2023)​,  this term is used to mask the recreational and dangerous use of the drug​.
• Barre: Barre, pronounced “bar,” refers to the prescription cough syrups used to create the mixture. It is a more niche term used among specific user groups to describe the substance.​

How Did Sizzurp Become Popular?

Sizzurp became popular through pop culture, hip-hop music, and promotion by influencers, which glamorized its recreational use and spread its appeal among young adults. The drink gained significant attention in the 1990s and early 2000s when hip-hop artists began referencing it in songs and music videos, portraying it as a symbol of luxury and relaxation. 

National data from the Substance Abuse and Mental Health Services Administration (SAMHSA) highlights that exposure to substance use in pop culture increases the likelihood of experimentation among adolescents and young adults, because of this, Sizzurp became synonymous with certain lifestyles depicted in hip-hop, leading to its widespread recreational use despite its significant health risks​.

What Are the Effects of Sizzurp on the Body and Mind?

The effects of sizzurp on the body and mind include euphoria, lethargy, impaired judgment, and long-term damage to vital organs and cognitive function. Long-term use leads to damage to the liver, kidneys, and brain, as well as persistent cognitive impairments, as reported by Ware et al. in Lean or Sizzurp Ingredients and Use, published in Substance Abuse: Research and Treatment (2023)​.

The effects of sizzurp on the body and mind are explained below:

• Respiratory Depression: Sizzurp suppresses the central nervous system, leading to dangerously slow or shallow breathing. This effect results in hypoxia, where the brain and organs are deprived of oxygen, potentially causing permanent damage or death. According to the National Institute on Drug Abuse (NIDA), respiratory depression is the leading cause of fatalities associated with opioid-containing substances like those in Sizzurp​.
• Addiction and Dependency: The presence of codeine, an opioid, in Sizzurp, creates a high risk of addiction and physical dependency. Repeated use alters brain chemistry, making users crave the substance to feel normal. A report by the CDC highlights that opioids, even in prescribed forms, quickly lead to addiction, especially when consumed in high quantities or mixed with other substances​.
• Impaired Cognitive Function: Sizzurp consumption leads to mental fog, poor decision-making, and slowed reaction times. This is due to the sedative effects of both codeine and promethazine, which impair communication between brain neurons. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) emphasizes that such impairments increase the likelihood of accidents and risky behaviors​.
• Liver Damage: The acetaminophen present in prescription cough syrups contributes to liver toxicity, especially when consumed in large quantities. Chronic use leads to liver failure, a life-threatening condition that requires medical intervention. The FDA reports that acetaminophen overdose is a leading cause of liver damage in the United States​.
• Cardiovascular Issues: Sizzurp causes irregular heart rhythms and low blood pressure, particularly when consumed with alcohol or other depressants. These effects increase the risk of fainting, heart attack, or cardiac arrest. According to the American Heart Association, mixing substances that depress heart function amplifies these risks significantly​.

How Does Sizzurp Make You Feel?

Sizzurp makes you feel relaxed, euphoric, and sedated, which are the primary reasons for its recreational use. The combination of codeine, an opioid, and promethazine, a sedative antihistamine, slows brain activity, creating a sense of calm and detachment from stress. 

However, these short-term pleasurable effects come with significant risks, including impaired motor skills, reduced cognitive function, and the potential for life-threatening respiratory depression. 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), substances like sizzurp that combine opioids and sedatives are among the most dangerous due to their high risk of misuse and overdose​.

How Long Do the Effects of Purple Drank Last?

The effects of purple drank last 4 to 6 hours on average, though this duration varies depending on the dosage and the individual’s metabolism. Higher doses prolong the sedative effects significantly, increasing the risk of dangerous side effects such as respiratory depression and impaired motor skills. 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the combination of opioids and antihistamines in sizzurp creates prolonged sedation that impairs normal functioning and increases the likelihood of dependency with repeated use​.

What Are the Immediate Effects of Consuming Sizzurp?

The immediate effects of consuming sizzurp include relaxation, drowsiness, slowed reaction times, and impaired motor skills. The combination of codeine, an opioid, and promethazine, a sedative antihistamine, works to suppress the central nervous system, creating a feeling of calm and euphoria. 

However, this sedation significantly slows brain and body responses, leading to delayed reaction times and difficulty performing tasks requiring coordination. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 80% of individuals misusing codeine-based substances report severe drowsiness and reduced cognitive function shortly after consumption, highlighting the dangers of recreational use​.

What Are the Long-term Health Consequences of Drinking Lean?

The long-term health consequences of drinking lean include liver damage, respiratory issues, addiction, and mental health problems. Prolonged use of codeine, an opioid, places significant strain on the liver, as it processes large amounts of the substance, increasing the risk of liver failure and chronic damage. 

The long-term health consequences of drinking lean are explained below:

• Respiratory Depression: Chronic use of lean significantly slow breathing rates due to the depressant effects of codeine and promethazine on the central nervous system. This respiratory depression increases the risk of hypoxia, where insufficient oxygen reaches vital organs, potentially leading to organ damage or death.
• Organ Damage: Prolonged intake of codeine and other components in lean causes significant harm to vital organs, particularly the liver and kidneys. The liver metabolizes codeine, and excessive use leads to liver damage or failure, while the kidneys suffer due to the body’s efforts to filter out toxins.
• Addiction and Dependence: Regular consumption of lean leads to physical and psychological dependence on codeine, an opioid. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), consistent misuse of opioids is a leading cause of substance-related mental health deterioration and contributes significantly to addiction rates in the U.S. Users experience withdrawal symptoms such as agitation, muscle aches, and insomnia when not consuming the substance, making cessation challenging without professional help.
• Dental Decay: The high sugar content in lean, from soda and candy mixed with cough syrup, leads to severe tooth decay and gum disease. Additionally, codeine causes dry mouth, reducing saliva production that helps protect teeth, thereby exacerbating dental issues.
• Seizures: Lean has been associated with an increased risk of seizures, particularly in individuals predisposed to them. The combination of codeine and promethazine disrupts normal brain activity, leading to convulsions and other neurological complications. 

Is There Any Addiction Risk Associated with Sizzurp?

Yes, Sizzurp carries a high addiction risk due to codeine’s opioid properties and the mental dependency caused by its euphoric effects. Codine triggers the brain’s reward system, reinforcing repeated use and leading to physical dependency as tolerance builds, requiring larger doses to achieve the same effect. The addition of promethazine enhances the sedative effects, increasing the risk of dependency by amplifying the relaxation and detachment users seek.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), opioids like codeine are among the most addictive substances, with millions of individuals in the U.S. developing dependency annually. 

Mental dependency on the euphoric state provided by Sizzurp further complicates addiction recovery, as users turn to the substance to cope with stress or emotional discomfort​.

Why is Sizzurp Highly Addictive?

Sizzurp is addictive due to codeine’s opioid properties, the mental dependence created by its euphoric effects, and the cycle of tolerance and repeated use that reinforces addiction. 

Codeine, as an opioid, binds to receptors in the brain, altering pain perception and triggering the release of dopamine, which creates a pleasurable and rewarding sensation. Over time, the body becomes reliant on the drug to maintain this state, leading to physical dependence and withdrawal symptoms when the substance is absent. 

Mentally, the euphoric effects of Sizzurp make users crave the relief it provides from stress or emotional discomfort, reinforcing repeated use.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 3 million Americans annually misuse prescription opioids like codeine, with many developing addiction due to the drug’s reinforcing effects on the brain’s reward system. This combination of physical and psychological dependency makes Sizzurp one of the most dangerous recreational substances for addiction​.

What Are the Warning Signs of Sizzurp Abuse or Addiction?

The warning signs of Sizzurp abuse or addiction include frequent drowsiness, slurred speech, impaired coordination, and an increasing need for higher doses to achieve the same effects. Behavioral signs, such as neglecting responsibilities, secretive consumption, and withdrawal symptoms like anxiety and agitation, also indicate addiction

The warning signs of sizzurp abuse or addiction are explained below:

• Lethargy: Sizzurp’s primary ingredients, codeine, and promethazine, suppress the central nervous system, leading to extreme fatigue and a lack of energy. Over time, consistent use causes persistent lethargy, which interferes with daily functioning. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), lethargy is one of the earliest signs of sedative misuse​.
• Slurred Speech: The sedative effects of promethazine and codeine impair muscle coordination, including those involved in speech. This results in slowed, unclear, and slurred speech, which is a hallmark of excessive or prolonged consumption​.
• Frequent Use of Cough Syrup: Individuals abusing Sizzurp display a pattern of acquiring and consuming large quantities of cough syrups containing codeine and promethazine. This behavior reflects dependency, as the user’s body craves the opioids to avoid withdrawal symptoms and maintain the euphoric state​​.
• Withdrawal Symptoms: Symptoms such as anxiety, agitation, and restlessness appear when Sizzurp use is reduced or stopped. These occur because the body has become dependent on the drug to regulate brain function, creating a cycle of addiction that is difficult to break without professional intervention​.

What Are the Warning Signs of Sizzurp Overdose?

The warning signs of Sizzurp overdose are severe respiratory depression, extreme drowsiness, confusion, and unresponsiveness. These symptoms occur because the combination of codeine and promethazine suppresses the central nervous system to dangerous levels, impairing breathing and brain function, which quickly become life-threatening without immediate medical attention.​

The warning signs of sizzurp overdose are explained below:

• Extreme Drowsiness: The excessive sedative effects of codeine and promethazine slow down brain activity, causing severe drowsiness that escalates to a state of stupor. This symptom indicates that the central nervous system is being significantly suppressed, which is a critical precursor to life-threatening complications​.
• Slow Breathing: Sizzurp overdose suppresses the respiratory centers in the brain, leading to dangerously slow or shallow breathing. This reduced oxygen intake results in hypoxia, which causes organ damage and, if untreated, death. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), respiratory depression is the leading cause of death in opioid-related overdoses, including Sizzurp​​.
• Unresponsiveness: At advanced stages of overdose, individuals become unresponsive or fall into a coma. This occurs as the central nervous system is overwhelmed by the sedative combination of codeine and promethazine, leading to a critical shutdown of brain function​.
• Bluish Lips and Fingertips: This symptom, known as cyanosis, results from a lack of oxygen in the blood caused by suppressed breathing. Bluish discoloration of the skin is a medical emergency and an indicator of severe respiratory failure due to a Sizzurp overdose​​.

According to data from the Centers for Disease Control and Prevention (CDC), opioid-related overdoses, including those involving codeine in substances like Sizzurp, account for approximately 70,000 deaths annually in the United States, underscoring the severity of this issue.

How Much Lean Can You Drink Before You Overdose?

You can drink a small amount of lean before you overdose, as the threshold for overdose varies based on individual tolerance, body weight, and sensitivity to the combination of codeine and promethazine. 

Even a single serving of Sizzurp is dangerous for individuals who have not built up a tolerance to opioids or sedatives. Due to the unpredictable nature of this mixture, there is no safe dose, as the risk of overdose increases dramatically when the substance is mixed with alcohol and other sedatives or consumed in higher quantities. 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), even one overdose incident has fatal consequences, and many users underestimate the potency of the mixture​.

What Are the Legal and Social Consequences of Using Sizzurp in New Hampshire?

The legal and social consequences of using sizzurp in New Hampshire include legal penalties for possession, misuse, and distribution, along with significant societal stigma. 

Under New Hampshire state law, possession of codeine and promethazine without a prescription is illegal, and violators face criminal charges ranging from misdemeanors to felonies, depending on the amount in possession and intent to distribute. 

New Hampshire Revised Statutes Annotated (RSA) 318-B:2 criminalizes the unauthorized possession of controlled substances like codeine, which is classified as a Schedule II substance. Violators face up to 7 years in prison and substantial fines. Additionally, misuse or distribution results in severe legal penalties, including longer prison sentences.

Socially, the use of sizzurp is associated with stigma, particularly due to its association with recreational drug abuse and the culture of misuse in certain communities. The societal consequences extend to damaged relationships, both personal and professional, as misuse of sizzurp affects a person’s mental health, job performance, and social interactions. 

According to SAMHSA, the negative perceptions surrounding opioid misuse and the growing awareness of the risks contribute to increased social isolation and difficulty accessing support networks for users​.

How to Address Sizzurp Addiction?

To address sizzurp addiction, seeking medical help and engaging in therapy are essential steps in the recovery process. Medical professionals provide supervised detoxification to manage withdrawal symptoms safely, ensuring that the physical aspects of addiction are addressed first. 

Following detox, therapy—such as cognitive-behavioral therapy (CBT)—helps individuals understand the underlying causes of their addiction and develop healthier coping mechanisms. Group therapy and support groups are also vital components of recovery, providing individuals with the community and accountability needed to maintain sobriety. 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), combining medical and psychological interventions is the most effective approach for long-term recovery from opioid and sedative addictions.

What Are the Most Effective Treatments Specifically for Sizzurp Addiction?

The most effective treatments specifically for sizzurp addiction are medically supervised detoxification, cognitive-behavioral therapy (CBT), and long-term outpatient rehabilitation. These approaches address both the physical dependence on codeine and promethazine and the psychological aspects of addiction, helping individuals regain control over their substance use.​

The most effective treatments specifically for sizzurp addiction are explained below:

• Detox: Medically supervised detox is the first critical step in treating sizzurp addiction, helping individuals safely withdraw from codeine and promethazine while being monitored for complications. During detox, the body is gradually rid of substances, and healthcare professionals manage withdrawal symptoms such as anxiety, nausea, and muscle pain to prevent relapse. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), supervised detox is essential for reducing the risk of serious withdrawal symptoms and ensuring a safe transition to further treatment​.
• Cognitive-Behavioral Therapy (CBT): CBT is an evidence-based treatment that helps individuals recognize and change unhealthy thought patterns and behaviors associated with sizzurp use. This therapy is particularly effective in addressing the psychological aspects of codeine addiction, teaching individuals how to cope with triggers, manage cravings, and avoid relapse. The National Institute on Drug Abuse (NIDA) highlights CBT as a cornerstone in addiction recovery due to its effectiveness in treating both the mental and emotional components of opioid use disorder​.
• Medication-Assisted Treatment (MAT): MAT involves the use of medications like buprenorphine and methadone alongside counseling to help individuals manage cravings and prevent relapse during recovery. MAT stabilizes brain chemistry, allowing individuals to focus on recovery without being overwhelmed by withdrawal symptoms. According to NIDA, MAT has been shown to improve outcomes for opioid addiction, including codeine dependence, by reducing cravings and preventing relapse​.

What Resources Are Available for Sizzurp Addiction in New Hampshire?

The resources available for sizzurp addiction in New Hampshire include inpatient residential treatment, outpatient counseling, and support groups. These opioid rehab programs in New Hampshire offer comprehensive care, combining detox, therapy, and medical support to help individuals recover from codeine and promethazine addiction.

The resources available for sizzurp addiction in New Hampshire are:

• New Hampshire Department of Health and Human Services (DHHS) Substance Misuse Treatment Services: This state-run program provides a range of services, including outpatient, intensive outpatient, partial hospitalization, residential, withdrawal management, and peer and non-peer recovery support services. Many of these services are funded by DHHS to assist individuals in accessing treatment for substance use disorders.
• NH Drug & Alcohol Treatment Locator: Operated by DHHS, this resource helps individuals find treatment agencies and practitioners offering substance use disorder services across the state. It serves as a valuable tool for locating appropriate care options for those seeking help with sizzurp addiction.

How Can We Prevent Sizzurp Abuse?

To prevent sizzurp abuse, public awareness campaigns, education, and prescription monitoring programs are essential strategies. Public awareness efforts focus on educating individuals, especially youth, about the dangers of opioid misuse, including substances like codeine found in sizzurp. 

Schools, media campaigns, and community outreach significantly reduce the likelihood of experimentation. Prescription monitoring programs (PMPs) also play a crucial role in preventing misuse by tracking the dispensing of codeine-based cough syrups, ensuring they are only prescribed to individuals who need them. 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), states with active PMP systems report a 40% reduction in the non-medical use of prescription opioids, including codeine-based medications​. Additionally, educating healthcare providers on the risks of overprescribing codeine-based cough syrup helps further limit its availability for misuse.

Are There Safer Alternatives that Avoid Addiction Risks? 

Yes, there are several non-opioid cough remedies, natural solutions, and safer prescription options available to manage coughs without the risk of addiction. Non-opioid cough syrups, such as those containing dextromethorphan, are widely used and do not carry the same dependency risks as codeine-based products. 

Natural remedies like honey, ginger, and steam inhalation have been shown to soothe throat irritation and alleviate coughing without the risk of side effects. For chronic or severe coughs, doctors recommend steroid-based inhalers or antihistamines, which treat underlying conditions like allergies or asthma. 

According to the National Institutes of Health (NIH), these alternatives are not only effective but also carry a much lower risk of misuse, providing safer options for individuals without the danger of addiction or respiratory depression​.