The sugary sweet drug contributing to the opioid epidemic
A Milwaukee rapper who goes by “C-Bandz” hoists a double-stacked plastic foam cup and a bottle of cotton candy-flavored Faygo. More insulated cups bob behind C-Bandz in the video for “New Milwaukee,” a song by a collective of young lyricists known as 414Work, and they’re not for coffee. The first rapper on the track, YBN Kenny, who’s wearing rumpled white jeans and a “Young Boss” T-shirt, rhymes about counting money and “sippin’ lean.”
“Lean” or “purple drank” or simply “sizzurp” is made by combining high doses of prescription opioid cough syrup and, most commonly, flavored soda. While such cough syrup has been abused for decades, this colorful new cocktail has become popular among young adults, teens and even younger children. “Ten-, 11-, 12-year-old kids are trying lean,” says Andre Lee Ellis, an activist in the city’s black community and founder of We Got This, a neighborhood revitalization group. “They can get lean in the morning before they go to school.”
It’s called lean because it’s highly sedating, combining the effects of the opiate painkiller codeine and the powerful antihistamine promethazine, which can cause a user literally to stoop and lean. The concoction can also cause a person to stop breathing. According to a report by the National Institute on Drug Abuse, lean, like other opiates, “presents a high risk of fatal overdose due to its effect of depressing the central nervous system, which can slow or stop the heart and lungs.” Opiates played a role in some 88 percent of the 269 drug overdose deaths that plagued Milwaukee County during the first 11 months of 2016, a record number. While codeine, as a lower potency opiate, may be harder to overdose on compared to high potency drugs like fentanyl and heroin, users may still mix it with alcohol or with benzodiazepines such as Xanax that can dramatically raise the chances for death.
Sippers can obtain the syrup needed to make lean with a prescription or by purchasing it on the street, where it’s much sought-after and a popular target for thieves. A local pharmacy chain, Hayat, which has locations on the North Side, now keeps the cough syrup locked up in a safe after a string of more than a dozen syrup-motivated burglaries during the summer of 2016.
Lean has deep roots in hip hop. The concoction was an essential part of the influential Houston rap scene in the 1990s and 2000s with songs distorted into slow, otherworldly remixes mimicking the effects of the drug. Tragically, lean played a role in the sudden deaths of several well-known Houston artists. Regardless, lean grew into a national phenomenon in the early 2000s, and in 2013, Atlanta artist Gucci Mane released a love song to syrup with the lyric, “Actavis, you are love,” referring to the brand most prized for making lean. Its maker has discontinued the product, wary of widespread “unlawful and dangerous use.”
During last summer’s Lil Wayne performance in Milwaukee, the rapper could be seen sipping from a double-stacked cup. On his flight to California, he experienced a barrage of seizures. The plane made an emergency landing in Omaha, where Wayne initially refused treatment. He later ascribed the attacks to not being able to get his seizure medication in Milwaukee.
“Music is where they get the attention of the young people,” says Ellis, who contends that lean “is a major problem” in the inner city. But Timothy Gauerke, spokesman for the Milwaukee Police Department, says it’s “not that widely encountered by officers and is not that prevalent” in the city.
Regardless, Ellis wants to push it into the open. “The community needs to come together,” he says. ◆
Your Brain on Lean
Opioid cough syrups are “sort of a farce that the pharmaceutical world put together over a century ago,” says Matthew Hearing, assistant professor of biomedical sciences at Marquette University. There’s little evidence that the opiates included, such as codeine, have anti-cough effects – most of the suppression is believed to come from the syrups’ antihistamines. What codeine can be used for is recreation, leading to its popularity as the key ingredient in lean.
What happens to someone’s brain when he or she drinks lean? Matthew Hearing: The initial euphoria, especially during the first few uses, is primarily due to increased dopamine levels throughout the brain. In the course of a day, if they’re drinking it in soda or something, you’re going to have a gradual dissociative effect where [it feels like] your mind is separated from your body.
What are the short-term risks? With extended use, you can have dangerously low respiration. [Lean] can lead to seizures in some cases and can produce a substantial amount of sedation, which can be a problem with kids if they’re out operating a motor vehicle.
At what point does lean become addictive? Outside of some molecular differences, codeine isn’t that different from more dangerous opiates such as heroin. It’s still addictive.
How hard is it to overdose? If [adolescents] do lean throughout the day, it can be very dangerous. If someone has a pulmonary condition, or an allergy to one of the compounds, it could be lethal.
Source: Milwaukee County Medical Examiner’s Office. *First eleven months; *Many overdose deaths involve more than one drug.