The 2006 arrest of San Diego Chargers starting safety, Terrence Kiel, exposed the popularity of a relatively obscure drug mixture known as “lean.” Kiel was arrested for allegedly shipping at least two parcels of Prometh prescription cough syrup to Texas and charged with two felony counts of transporting a controlled substance and three counts of possession for sale of a controlled substance (Associated Press, 2007). A one-pint bottle of “lean” has a street price of between $200 and $325, but can fetch as much as $500 (National Public Radio, 2001).

Usually purple in color, lean is a drink made by mixing codeine cough syrup with soda, wine or juice. The concoction — also called syrup, Barr or purple drank — generally causes users to lose their balance and lean to the side.

Codeine-based cough syrup can be used to enhance, moderate or temper other drugs, including cocaine and PCP. Hydrocodone, a semi-synthetic opioid found in several cough syrups, is a less popular component also used to make lean.
Another lean concoction is made by using over-the-counter syrups containing dextromethorphin, such as Robitussin DM, NyQuil and Coricidin. DXM, a synthetic morphine analog, has been on the market since the 1960s, and acts as a cough suppressant when taken in small doses of 15 to 30 mg. In larger amounts, DXM promotes a disassociative state with hallucinations similar to the effects of PCP or ketamine. There are about 100 varieties of this product, most containing dextromethorphan hydrobromide. Familiar examples include Coricidin, Dexalone Liquicap, Robitussin Cough Gels, Robitussin Maximum Strength Cough Syrup and Vicks 44 Liquicaps.

On the street, the substance is known as DXM, DEX, “Robo, or Triple C. Although it is not a controlled substance, the DXM abuse is dangerous because it could cause brain damage and death. In 2005, the U.S. Food and Drug Administration issued a warning about the abuse of DXM after the death of five teenagers who consumed the substance in powered capsules.

About five percent of 12- to 25-year-olds have misused over-the-counter cold and cough medicines to get high, according to federal researchers (Join Together, 2008). The Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Drug Enforcement Agency (DEA) have warned about the growing abuse of DXM and codeine-based medications. Both substance abuse trends are a further indication of the rampant misuse of pharmaceutical drugs. Current research indicates that whites are three times more likely to abuse cold and cough medicines as blacks, with use rates similar to those of LSD, methamphetamine and ecstasy. The penalty for illegal possession of codeine is only a Class B misdemeanor, even though the DEA has found extensive abuse of lean in some areas of Florida and Texas (Leinwand, D., 2006).

Popularized in numerous songs by rappers such as Kanye West and Lil’ Wayne, and reflected in LP’s City of Syrup and Purple World, the lean drug culture has emerged with its own unique musical genre. Three 6 Mafia’s song, Sippin On Some Sizzurp, sold over one million records (National Public Radio, 2001), as it promoted “purple stuff” to a mainstream audience. Yet another variation of the lean musical genre is “screwed music.” Developed in 1989 by Houston’s Robert Earl Davis (a.k.a. DJ Screw), the music slows down hip-hop tunes and “stretches it out like taffy” to emulate the lean drug experience. The use of codeine, hydrocodone and DXM in the lean concoctions is risky and dangerous. Overdose symptoms may include agitation, coma, confusion, deep sleep or loss of consciousness, difficulty breathing, diminished mental alertness, hallucinations, hot or cold skin, large and unchanging pupils, sedation, seizures, shaking, sleeplessness, slow heartbeat and slowed breathing (Drugs.com, 2008).

“The antihistamine appears to be the major contributor to the [lean] overdoses. [I]n all of those different formulations … no matter what the opiate is — codeine, oxy, hydro, DXM — there is also promethazine or a similar antihistamine in the street formula. It is the combination of the antihistamine and opiate that they [users] are going for” (Dickinson, 2008).

In his song, Purple Rain, Rapper Beanie Sigel warned about the dangers of prescription cough syrup. He said “The first time you sip it, you mite get addicted/Matter of fact, I know you’ll get addicted” (CMT, 2008). In 2000, 29-year-old rapper DJ Screw 29, died from a codeine overdose with traces of Valium and PCP in his blood; and in 2007, influential Texas rapper Pimp C was found dead in a West Hollywood hotel, “due to promethazine and codeine effects,” according to the Los Angeles County Coroner’s office (Black Voices, 2008). Houston-based rapper Big Moe is yet another casualty that is attributed to lean. Purple drank is believed to have contributed to Big Moe’s death at age 33. Ironically, Moe’s song, Leave Drank Alone, may have been his musical cry for help as he warned others about the dangers of this narcotic cocktail.
“It’s tragic what happened,’’ said Crisco Kidd about Moe’s untimely death.”Maybe his death tells us it’s time for everyone to put their cup down.’’

References

Associated Press. (2007). Chargers’ Kiel pleads guilty in attempt to avoid jail. Retrieved at http://sports.espn.go.
com/nfl/news/story?id=2757813.
Country Music Television, Inc. (2008). Beanie Sigel – Purple Rain. Retrieved at http://www.cmt.com/lyrics/beanie-sigel/purple-rain/8023409/lyrics.jhtml
Dickinson, K. (2008). Basic Pharmacology of Drug Abuse. Seminar conducted at the Training of Trainers meeting of the Bureau of Drug and Alcohol Programs, Harrisburg, PA.
Drugs.com. (2008). Retrieved at http://www.drugs.com/
cdi/hycodan-syrup.html
F.DA. (2005). FDA warns against abuse of Dextromethorphan. FDA Talk Paper. Retrieved at http://www.
fda.gov/bbs/topics/ANSWERS/2005/ANS01360.HTML
Join Together. (2008). Feds Alarmed About Abuse of Cough Medicine. Retrieved at http://www.jointogether.
org/news/headlines/inthenews/2008/feds-cough.html Hycodan Syrup.
Leinwand, D. (2006). DEA warns of soft drink-cough syrup mix. USA Today. Pimp C: Codeine Overdose Linked to Death. (2008). Black Voices. Retrieved at http://www.blackvoices.com/blogs/2008/02/04/pimp-c-codeine-overdose-linked-to-death/
National Public Radio. (2001). Codeine Syrup & Screwed Music. All Things Considered from National Public Radio. Retrieved at http://www.pcdpap.org/files/screwed.htm

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