All You Need to Know About Codeine

One of the most dangerous substances being abused by people these days is codeine. However, not many people know about this particular compound – rather, most users know this substance as “purple drank”. In this article, we will learn more about purple drank, and codeine in particular.

What is Purple Drank?

Purple drank is a drug concoction made with codeine cough syrup mixed with carbonated drinks and hard candy. It is commonly known as “syrup”, “lean”, “Texas Tea”, “dirty Sprite” and the more popular term “sizzurp”.

Purple drank emerged as the drug of choice by celebrities and professional themes. The substance has figured in several music festivals, which have catapulted this dangerous mix into a media frenzy.

This cold medication contains promethazine and codeine, which is combined to make a purple drink that induces euphoria and dissociation from the body. This recreational drug is a popular choice of drug in the Southern United States.

This illegal recreational drink is usually taken way beyond the medically approved dose. The amount of cough syrup may exceed up to 25 times than the usual recommended dosage. This addictive brew is known as a dissociation drug similar to ketamine and can be a health hazard when abused. Its active ingredient is codeine, known to be an opiate medication that can be extremely addicting.

Meanwhile, purple drank can also contain antihistamine medication like promethazine that produces a mild sedative effect. If mixed together and taken in large quantities, sedation and altered state of mind are some of its known effects.

Actavis announced last 2014 that they will cease production of the prescription cough syrup that has become a popular choice in mixing up Sizzurp. Actavis is a pharmaceutical company known to be the biggest distributor of cough syrup with promethazine and codeine in the mixture. Upon realizing this, Actavis decided to stop all production and sales of the said cough syrup.

Codeine works by suppressing cough while promethazine works by blocking the action of histamine to reduce symptoms of allergies, such as a runny nose, sneezing or nausea. The use of codeine/promethazine syrup must be supervised by a physician.


Purple Drank Abuse

Today reported that doctors are warning the public of the dangers of this substance. A statement made by Lenox Hill Hospital in New York declared that purple drank can be a very dangerous drug because it can lead to seizures and may even lead the patient to stop breathing.

The primary and active ingredients of the Texas Tea brew are promethazine and codeine, which can only be available upon prescription. The Sizzurp mixture is popular in the hip-hop industry and has been the topic of countless songs that encourage others to use this recreational drink.

History of Sizzurp Abuse

The admission of rapper Lil' Wayne to the ICU at Cedars-Sinai hospital in Los Angeles has put to light the dangers of drinking sizzurp, or more popularly known as purple drank. Even though the multi-platinum hip hop recording artist denied that his near-death experience had something to with sizzurp, the rumor mill continues to mention the dangerous drink as the culprit of his seizures.

First of all, since when exactly did sizzurp become a favorite drink among the youth? Why should parents worry about it?

Robert Earl Davis Jr., a Houston disc jockey known as DJ Screw, was said to be the one who popularized the concoction of cough syrup and soft drink in the late 1990s. Many a time, hip-hop musicians have rapped about the drink. Among those rappers who referenced the mixture in their lyrics include D12, Eminem, Lil' Wayne, Big Moe, Lil' Wayne, Ludacris, Slim Thug, Mack Maine, and Fat Joe.

Lil' Wayne, in particular, has openly acknowledged his fondness for purple drank. In the music video Duffle Bag Boy, he was featured holding a Styrofoam cup with "RIP DJ Screw" written on it.

The mere mention of sizzurp in music has augmented its popularity, leading up to the awareness of some teenagers and young adults across the country.

In concocting sizzurp, users typically mix an ounce of cough syrup -- containing codeine and promethazine -- with Sprite or Mountain Dew and dissolved Jolly Rancher candy for extra sweetness, and pour it over ice. The drink is known to give users the euphoric high. However, other side effects include motor-skill impairment, lethargy, nausea, drowsiness, hallucinations, seizures, and even death.

In fact, some notable deaths linked with codeine overdose include that of DJ Screw in 2000; Big Moe, a DJ Screw protégé, in 2007; and Pimp C, a Texas rapper and a member of rap duo UGK, in 2008.

The U.S. Drug Enforcement Administration had warned people about the rising trend of cough syrup abuse. Although it is unclear as to how many people are drinking sizzurp, numerous health experts and the law enforcement are cautioning people about the fatal effect of cough syrup misuse. Officials are also using drug testing to ensure people do not abuse the drug in public.

Side Effects of Cough Syrup Abuse

There are different signs that show up when a person has abused purple drank. The prevailing signs of Sizzurp abuse include:

  • Slurred speech
  • Lethargy
  • Drowsiness
  • Sedation
  • Altered state of mind
  • Impaired motor skills

The high that users get from taking this mixture is referred to as “swooning euphoria” because it usually stimulates fainting, periods of blackout, and the tendency to lean on objects for support because it impairs and affects motor skills.

If purple drank is taken in high dosages, some of the unpleasant signs that users experience include vomiting, hives, chest pain, hallucinations, seizures, and tremors.

Purple drank users are often described to be going through sudden changes in behavior and experiencing mood swings and withdrawal symptoms.

When taken in large amounts or combined with alcohol for recreational use, codeine/promethazine syrup may trigger more dangerous impact, such as confusion, hallucinations, irregular heartbeat, tightness in the chest, seizures, tremors, and uncontrolled muscle movements.

The Scope of Purple Drank Abuse

Addiction Center concluded that there are roughly 33 million people who use codeine every year. Meanwhile, about 4.7 million are considered to be addicted to the dangerous mixture as reported in the 2008 National Survey on Drug Use and Health. Between 2004 and 2008, about 152% of emergency visits involved painkillers, codeine, and promethazine.

Purple drank is a breathing depressant and can be a deadly choice especially when mixed with alcohol and other illicit drugs like ecstasy (MDMA).

There are locations that tend to have a higher population of purple drank users than other places. A report by concluded that Texas, Florida and Philadelphia are noted as locations with the highest level of Sizzurp abuse. The reason why this type of recreational drug is addictive is that the active ingredient codeine is an entry-level drug that induces and promulgates addiction.

Effects of Sizzurp Addiction

Purple drank – also known as Sizzurp and Texas Tea – is gradually becoming a popular choice in getting high. Some of the effects caused by purple drank abuse include constricted pupil, raspy voice, uncontrolled eye movement, loss of coordination and drowsiness.

The physiological effect of purple drank on the user includes a dissociative feeling from the body. It may also produce motor-skill impairment and lethargy. The effects of purple drank usually last within three to six hours but frequent users can usually last longer. There are also instances wherein purple drank users get codeine overdose, resulting in opiate overdose and death.

Health hazards arise when the mixture of cough syrup and antihistamine is taken in high dosages. Promethazine is a depressant that directly affects the central nervous system, while codeine is a respiratory depressant. If taken in large amounts, it may cause the user to stop breathing because the entire central nervous and respiratory systems shut down. The risk of this happening is usually when purple drank is taken alongside alcohol and ecstasy.

When taking purple drank, codeine enters the brain to stimulate the receptors, which makes the users feel euphoric. If abused and frequently used, the brain gets used to the stimulant, leading users to feel the need to take higher doses of codeine.

Dr. George Fallieras, an emergency room physician and hospitalist at Good Samaritan Hospital, told Los Angeles Times that the codeine ingredient in cough syrup serves as a pain reliever and also suppresses coughing, while promethazine is used as an antihistamine and commonly used to treat motion sickness and nausea. The codeine and promethazine contents in cough syrup are generally safe when taken in appropriately-prescribed quantities, but when taken in very large amounts can cause people to stop breathing.

There is also a risk of overdosing which is one of the main causes of death of cough syrup addiction. Another risk is when the cough syrup with the ingredient DXM is mixed with other medications or ingredients such as “non-drowsy” antihistamines, SSRI antidepressants and the Yohimbe herb; they can produce a deadly cocktail.

Sizzurp Withdrawal Symptoms

Since purple drank is highly addictive, users who abruptly stop the use of the drug may experience withdrawal symptoms that can last for a week or more with frequent use.

Some of the symptoms experienced during withdrawal include:

  • Insomnia
  • Lower threshold for pain
  • Depression
  • Muscle aches
  • Headaches
  • Nausea

Withdrawal symptoms usually last for a few days to a week, while depression may take months before it can be overcome.


Codeine/promethazine syrup should not be taken by people who are allergic to codeine-related medicines or any ingredient in codeine/promethazine syrup. It is also not recommended for patients with severe drowsiness, asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, fever, diarrhea caused by food poisoning or antibiotic use, and productive cough.

Additionally, pregnant women and patients with a history of heart problems, low blood pressure, seizures, substance abuse, liver or kidney problems, and bladder problems must share these conditions to their healthcare provider before taking codeine/promethazine syrup

Treatment of Purple Drank Addiction

The biggest challenge in the growing addiction to purple drank is that it can be easily mixed, with codeine or cough syrup being easily accessible in the black market. Fortunately, there are different options for the successful and efficient detox for codeine and promethazine. These three detoxification options include Cold Turkey, Tapering Off, and Substitution.

Cold Turkey is a highly preferred detoxification process for purple drank abuse, but it can be extremely hard to fulfill. Over the course of several months of abstinence to sizzurp, recovering addicts may experience long-term withdrawal symptoms such as insomnia, cravings, and anxiety.

These detoxification processes can be an effective method to wean off and get off the addiction. However, self-detox can be highly dangerous especially if done without the supervision of the medical personnel. Self-detox may lead to heart failure, convulsions, anxiety, delirium tremens, and hallucinations. The extent of the severity of the symptoms varies on the history of abuse and the user’s physical condition. It is still best to seek professional help to treat purple drank addiction because constant monitoring of medical staff and proper intake of medication is the key to combat the addiction.

The most common medical treatment for codeine and purple drank addiction is clonidine. This medicine can greatly reduce the impact of withdrawal symptoms brought about by purple drank addiction. The medication works directly on the body’s nervous system.

There are also some other treatment options such as the use of buprenorphine. The substance works to prevent codeine from accessing its opioid receptors, through the activation of the opioid blocker ingredient naltrexone or naloxone.

Another treatment option in combating purple drank addiction is non-medication based treatment. This form of treatment is a support option for sizzurp users and usually includes psychotherapy as its form or baseline of treatment.

One of the commonly used psychotherapy treatments is behavioral therapy. Behavioral approach as a treatment for addiction works because it helps engage users in drug abuse treatment. It also works as an encouragement for them to abstain from using this drug.

Another effective form of therapy that works in codeine abuse is contingency management interventions or motivational incentives. This type of intensive-based intervention therapy is highly effective in increasing the retention of treatment and promoting the abstinence from drugs.

Another helpful therapy that can promulgate the user to undergo treatment for addiction is group counseling and family counseling. An effectual intervention can only work if users feel supported by their loved ones. This form of therapy is highly effective because drug users need to undergo a set of tedious treatment and therapy sessions to combat addiction, and any form of support can mean a great deal to them.


Purple drank has become a popular form of addiction as it seems to be widely accepted by the hip-hop industry. Some celebrities have been very vocal in advocating this as their form of addiction. Some people have even used social media to promote and even share instructions on how to create this dangerous mixture. Some musicians have also introduced the concept of purple drank use in their songs.

Addiction to this visually alluring purple drink can be considered as a disease that is slowly eating the society. It is hard to get off from addiction and even harder to overcome withdrawal symptoms. However, it can still be treated.

The treatment of this form of addiction can only be effective if recovering addicts are open to making the change within. The support of families and friends is also highly important in ensuring that they are getting all the help they need. Lastly, users should be able to access a treatment center that can cater to their personal needs to alleviate and get well from this toxic addiction.