Codeine Cough Syrup: Definition, Side Effects, & Treatment

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By: Renaissance Recovery

Medically Reviewed by: Diana Vo, LMFT

Last Updated: 7/1/2021

An image of Codeine cough syrup

Authored By: Joe Gilmore

Table of Contents

Codeine is an opioid-based prescription medication.

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

What is Codeine?

Codeine is a narcotic analgesic. This prescription opioid is typically administered for the treatment of mild to moderate 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. Withdrawal is a physical and psychological response to the absence of the opioid in your system.

What Is Lean?

Lean drug is named for the effects it delivers – after drinking lean, it is common for people to lean to one side, slouching while intoxicated. Lean became more prevalent in the late 1990s, as it was frequently referenced by rappers and other music artists. Perhaps the most striking example of this was Future’s Codeine Crazy, an homage to lean drink.

Lean is a combination of substances that can trigger feelings of relaxation and euphoria, inducing a floaty and dreamy sensation. Since lean is not a packaged product, the makeup and quantities of the components of lean drink can vary substantially.

The most popular ingredients for lean drug are:

  • Cough syrup containing codeine
  • Promethazine
  • Soda
  • Hard candies

Often, people mix cough syrup with alcohol when making a lean drink.

An alternative version of lean drug included cough syrup containing DXM (dextromethorphan).

You can find variations of lean drugs involving codeine tablets added to a mixture of cough syrup and soda.

While the amount of the ingredients used to make lean varies, people typically use far more than the recommended doses.

Lean acts on the CNS (central nervous system), slowing brain activity and delivering a sedating effect.

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 ingredient 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 depressant 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 severe side effects. These include:

  • Sedation
  • Euphoria
  • Impaired coordination
  • Dizziness
  • Dissociation
  • Slowed breathing rate and heart rate
  • Withdrawal symptoms
  • Cravings
  • Addiction (opioid use disorder)
  • Seizure

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

  • Memory loss
  • Cognitive impairment
  • Liver damage
  • Behavioral changes
  • Epilepsy
  • Permanent psychosis

There is also a risk of overdose when using codeine cough syrup. Opioids can depress breathing 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.

Codeine Rehab at Renaissance Recovery

Before you engage with codeine rehab, 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.

Following detox, you will be ready to tackle the psychological component of codeine addiction. At Renaissance, 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 treatment intensity makes the best fit, you can access a combination of evidence-based therapies and holistic interventions at our luxury Orange County treatment 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 living codeine-free by calling admissions at 866.330.9449.

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