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Codeine Cough Syrup: Abuse & Treatment

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Medically Reviewed By: Diana Vo, LMFT

May 21, 2024

Table of Contents

Codeine is an opioid-based prescription medication.

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Typically used for the treatment of mild pain or as a cough suppressant, codeine is a schedule II controlled substance. Like all substances in this category, codeine has a high potential for both abuse and addiction.

The main way in which codeine cough syrups are abused involves mixing the syrup into soda or alcoholic beverages. This intoxicating combination is known as lean drink, lean drug, and many other names, including:

  • Syrup
  • Sizzurp
  • Purple drank
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Is Codeine an Opioid?

Yes, codeine is an opioid pain reliever. Although milder than other opioids, it binds to the same brain receptors, producing pain relief and cough suppression.


What is Codeine?

Codeine is a highly addictive narcotic analgesic. This prescription opioid is typically administered as a medicine to relieve pain from moderate to mild pain.

You can find codeine as a single-ingredient or combination product. Codeine is used together with aspirin or acetaminophen for pain relief, and also in some cold medications and cough syrups.

While codeine is an effective painkiller, long-term use is likely to trigger physical dependence and addiction in the form of OUD (opioid use disorder).

If you become dependent on an opioid like codeine, intensely uncomfortable withdrawal symptoms will manifest. Opioid withdrawal is a physical and psychological response to the absence of the opioid in your system.

What is Codeine Used For?

Codeine is primarily used for:

  • Short-term relief of mild to moderate pain: It's often combined with other pain relievers like acetaminophen.
  • Reducing cough: Due to its cough suppressant effect, it's sometimes found in cough syrups (though use is decreasing due to safety concerns).


Codeine is an opioid painkiller used for the treatment of mild and moderate pain. Codeine is also available in isolation and in combination with other medicines like Solpadol. You can also find codeine in some cough and cold medicines. This is typically the source of codeine in lean drinks.

The effects of codeine are similar to the effects of other addictive opioids, from oxycodone to heroin. Lean contains up to 25 times the recommended dose of codeine. Effects take hold within 30 to 40 minutes, peaking within an hour or two. The lean high lasts for four to six hours.

Promethazine is an antihistamine used to alleviate the symptoms of hay fever, eye inflammation, and allergic reactions. Promethazine works by inhibiting the effects of histamine in the body.

When combined with alcohol or other CNS depressants, promethazine will intensify the effects of those substances, causing extreme drowsiness.

The alcohol contained in many versions of lean drink triggers the usual effects associated with alcohol, while at the same time magnifying the effects of the other lean ingredients.

If lean is made using DXM, this can trigger effects similar to ketamine and PCP in high doses, a phenomenon known as robotripping. The result is a potentially dissociative experience like with out-of-body hallucinations.

Several studies have reported the misuse of cough syrups containing promethazine and codeine due to its euphoric and tranquilizing effects.

The ingredients of lean trigger increased production of dopamine in the reward system of the brain.

Codeine, like all opioids, can be addictive when used long-term or when abused.

Is it an Opioid?

Codeine is both an opioid and an opiate.

CDC (Centers for Disease Control and Prevention) outlines the difference between these two terms as follows:

  • Opiates: natural opioids like codeine, morphine, and heroin. These chemical compounds are extracted from the sap and fibers of opium poppies.

  • Opioids: an umbrella term used for all opioids, whether natural, semi-synthetic, or synthetic. These chemical compounds are not typically derived from plant matter. Most opioids are made in laboratories (synthesized).

Codeine is an opiate specifically, and part of the opioid family. According to NIDA (National Institute on Drug Abuse), codeine binds to the mu-opioid receptor in the brain. Once ingested, codeine is converted into morphine in the body, helping with pain relief.

Codeine Cough Syrup Side Effects

The main component of codeine cough syrup is a mild narcotic, meaning it is often targeted by those seeking a rewarding high.

Since many codeine-based cough syrups no longer contain alcohol, beverages like lean (codeine cough syrup) are often mixed with alcoholic drinks. Some cough syrups also contain DXM (dextromethorphan) or promethazine, both potentially intoxicating substances.

Codeine cough syrup and associated syrups contain:

  • Codeine

  • Alcohol

  • Other depressants of the CNS (central nervous system)

The combination of these substances and the way in which they act on the CNS can trigger a variety of potentially serious side effects. These common side effects include:

  • Sedation

  • Euphoria

  • Impaired coordination

  • Dizziness

  • Dissociation

  • Blurry vision

  • Stomach pain and nausea

  • Slowed breathing rate and heart rate

  • Withdrawal symptoms

  • Cravings

  • Addiction (opioid use disorder)

  • Seizure

Abusing codeine cough syrup long-term can cause the following dangerous effects:

  • Memory loss

  • Cognitive impairment

  • Liver damage

  • Behavioral changes

  • Epilepsy

  • Permanent psychosis

There is also a risk of codeine overdose when using this type of cough syrup. It can lead to a number of serious health effects including respiratory depression to the extent of oxygen deprivation. Mixing alcohol and opioids intensifies the effects of both substances.

The other primary risk of using cough syrups containing codeine is the risk of developing an opioid addiction.

An image of Codeine cough syrup

Codeine Addiction

Addiction to opiates like codeine can develop quickly. Opioid use disorder can also be challenging to overcome.

Resultantly, cough syrups containing codeine have been removed from the shelves at pharmacies to be sold over the counter. There are also legal restrictions in the United States limiting the concentration of codeine in certain cough medications. Codeine cough syrups are classified under schedules III to V, according to the formula.

Tolerance to codeine can form rapidly. The rate hinges mainly on your body chemistry and how quickly you metabolize opioids. As the effects of codeine diminish, taking more of the opioid can cause physical dependence to manifest. When this occurs, you will require codeine to function normally and experience withdrawal symptoms in its absence.

The most recent National Survey on Drug Use and Health (NSDUH 2020) shows that 2.6 million U.S. adults developed an opioid use disorder like codeine addiction in 2020. Among those, 805,000 engaged with professional treatment.

If you are ready to commit to recovery from codeine cough syrup addiction, we can help you from detox to discharge and beyond here at Renaissance Recovery Center.


Our compassionate team is one call away. Here to help every step of the way.

Cough Syrup Addiction Treatment at Renaissance Recovery

Before you engage with codeine treatment, a supervised medical detox provides the safest and most comfortable approach to withdrawal. We can connect you with suitable licensed detox centers in Southern California as well as inpatient treatment options.

Following detox, you will be ready to tackle the psychological component of codeine addiction. At Renaissance’s rehabs in Florida and California, we focus on providing outpatient treatment for those with addictions, mental health disorders, and co-occurring disorders. This allows you to benefit from structured and supportive therapy without the costs or the restrictions of residential rehab.

Whatever level of substance abuse treatment intensity makes the best fit, you can access a combination of evidence-based therapies and holistic interventions at our luxury rehab facility.

Most opioid use disorders respond positively to integrated therapy involving MAT (medication-assisted treatment), psychotherapy like cognitive behavioral therapy, and counseling.  Access a personalized array of these treatments here at Renaissance, surrounded by peers undergoing similar experiences.

Take the first step to getting help for your substance use disorder by our admissions team for professional help at 866.330.9449.



At Renaissance Recovery our goal is to provide evidence-based treatment to as many individuals as possible. Give us a call today to verify your insurance coverage or to learn more about paying for addiction treatment.

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Joseph Gilmore has been in the addiction industry for three years with experience working for facilities all across the country. Connect with Joe on LinkedIn.

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