What is Lean Drink? Understanding Risks & Treatment Options

What is in Lean?

Codeine Cough Syrup

Lean is created using a prescription cough syrup containing codeine. Codeine is classified as an opioid. Prescription cough syrups containing codeine provide relief for coughing and mild pain. At higher doses, codeine can produce euphoria, a feeling of intense happiness or contentment, along with dangerously slowed breathing.[2]

Promethazine

Most recipes for making lean include promethazine, an antihistamine that is frequently prescribed to alleviate nausea, allergic reactions, or motion sickness. Additionally, promethazine is a potent sedative. Sedatives slow down the central nervous system (CNS), which encompasses the brain and spinal column. Combining promethazine with codeine intensifies sedation, which raises the risk of dangerously slowed breathing.[3]

Soda and Hard Candy

Users of lean will often mix the drink with sodas, such as Sprite, in addition to various flavors of soda. Users of lean will often add flavored candies such as Jolly Ranchers to improve the flavor of the drink. Adding these items to lean does nothing to decrease the risks associated with consuming codeine or promethazine. Conversely, these additives may give users a mistaken belief that lean is a relatively safe, non-threatening substance rather than a potentially hazardous compound.[4]

Alternative Recipes

There are numerous alternative recipes for lean. Substitutes for codeine may include DXM (dextromethorphan), a common cough suppressant with its own risk of misuse. Alternatively, some recipes may utilize illicit combinations without regard for safety. Due to the variability in recipes used to prepare lean, the exact amount and type of chemicals present in each individual recipe may be completely unknown. As such, there exists a substantially increased risk of an unintended overdose occurring.[5]

Why Do People Use Lean?

Individuals use lean for similar reasons that others use substances: to relax, feel euphoric, or experience a sense of tranquility due to sedation. Peer pressure, social media, and musical culture contribute to lean’s visibility and appeal among young people, especially considering its association with hip hop culture. Lean originated in Houston and later became associated with hip-hop culture, which helped increase its visibility. This cultural association does not make the drink any safer. Behind the images lies a cocktail of compounds that can pose severe threats to an individual’s health.[6]

Effects of Lean on the Body

Effects of Short-Term Exposure to Lean

Exposure to lean over a short period can elicit various immediate effects on the body, including:[7]

• Drowsiness
• Dizziness
• Speech slurring
• Impairment of judgment
• Slow heartbeat
• Respiratory depression, defined as breathing that is too shallow or occurs too slowly
• Nausea
• Constipation

Effects of Long-Term Exposure to Lean

Regular exposure to lean can lead to serious and permanent negative effects on the body such as:[8]

• Physical dependence
• Opioid addiction
• Damage to liver cells
• Cognitive impairment: reduced ability to remember, decreased concentration, and reduction in cognitive clarity
• Mood changes
• Hallucinations
• Seizure activity
• Increased weight gain
• Chronic constipation

Is Lean Addictive?

Yes. Lean is highly addictive because it contains codeine, an opioid that can create dependence even with short-term use.[9]

Why Is Lean So Addictive?

Codeine binds to opioid receptors in the brain, causing an increase in the production of dopamine (the chemical responsible for producing feelings of pleasure and reward). Over time, the brain develops expectations regarding the presence of dopamine release, resulting in tolerance, needing additional quantities of the substance to attain equivalent levels of intoxication. Developing tolerance frequently results in dependency upon the substance, requiring support systems to address cravings once detoxification has begun.[10]

Can Someone Develop an Addiction Quickly?

Due to misconceptions surrounding lean as merely cough medicine mixed with soda, many users believe that developing an addiction will occur gradually. However, due to lean containing an opioid, users may develop an addiction much quicker than they initially anticipated, regardless of whether or not they intended to establish a habitually abusive relationship with the substance.

Withdrawal Symptoms of Lean

When someone physically dependent on lean ceases using it, withdrawal symptoms will likely manifest, including:[11]

• Muscle pain
• Insomnia
• Anxiety
• Nausea
• Irritability
• Cravings

These symptoms signify physical dependence on opioids and represent a major obstacle hindering recovery from opioid addiction without professional intervention.

Hazards Associated with Consuming Lean

• Risk of Overdose: Because lean contains both an opioid and a sedative, it carries all the overdose risks associated with opioid use, including dangerously slowed breathing.[12]
• Risk of Mixing Lean with Alcohol or Other Substances: Ingestion of lean coupled with alcohol or other substances which impair respiratory function or slow down heart rates significantly elevates the risk of overdose. The cumulative effect of slowing down both breathing and heart rates simultaneously presents an elevated risk compared to ingestion of a single substance alone.[13]
• Risk of Fentanyl Contamination: Cough syrup obtained outside of a licensed pharmacy and/or counterfeit pills obtained through street purchases may have been adulterated with fentanyl or other potent substances. Research conducted by SAMHSA indicates that illicit substance supplies are now frequently tainted with unforeseen substances that increase fatality risks for users.[14]

Which Groups Are More Susceptible to Misuse and Addiction to Lean?

Although anyone can develop an addiction to lean, there exist several demographics that are at greater risk for developing an addiction:

• Teenagers
• Young adults
• Individuals with a history of opioid misuse
• Those with mental health disorders
• Individuals that regularly combine multiple substances

Identifying That a Person Has Developed an Addiction to Lean

Physical Indicators:

• Extreme drowsiness
• Poor motor skills coordination
• Pinpoint pupils

Behavioral Indicators:

• Secrecy
• Doctor shopping
• Decline in academic or occupational functioning
• Social isolation

Psychological Indicators:

• Cravings
• Impatience
• Agitation
• Mood swings

Support During Recovery

Recovery from addiction does not cease immediately following detoxification. Long-term support, including peer support groups, relapse prevention planning, post-treatment care services, and family therapy, enables individuals to establish stability and sustainability in their life after addiction.

Alpas NOVA offers support for those recovering from lean or opioid addiction. We are committed to providing supportive services for individuals looking to start down their path towards recovery from lean or opioid misuse.