What is lean drink, and why is it dangerous?
Lean is codeine syrup mixed with a cool drink, also called purple drank or sizzurp. What is in it, what it does, what South African law allows, the 2025 data, and what parents in Cape Town can do this week.
Lean is a drink made by mixing codeine syrup with a fizzy cool drink, often with sweets dropped in for colour, and it also goes by purple drank, sizzurp and dirty sprite. In South Africa it is cheap and easy to make: a 2022 report put a session at R20 to R30 for a 100ml bottle of Stilpane or Broncleer, plus R20 for a Sprite (Daily Maverick).
Parents usually find out the same way: sticky purple bottles in a school bag, cough mixture missing from the cupboard, a teenager who sleeps through Saturday. We treat codeine dependence at our residential centre in Lakeside, Cape Town. Parents want four things answered first: what lean is, what it does, whether it is legal, and what to do at home this week.
Found syrup bottles in your child’s room? Message us on WhatsApp for a free, confidential call. We reply the same day.
What is in a lean drink?
The working ingredient is codeine, an opioid painkiller and cough suppressant. The classic recipe uses a codeine and promethazine cough syrup, and medical reviews describe recreational use of “codeine/promethazine cough syrups” as widespread (review, 2013). Promethazine is a sedating antihistamine that deepens the drowsiness.
In South Africa the base is whatever codeine syrup is easiest to buy. Stilpane and Broncleer are the two names that come up in local reporting, and some people use other codeine painkillers dissolved into the drink. The soft drink and the sweets only change the taste and colour. That matters because colour tells you nothing about how much codeine is in the cup.
A 2025 review notes that the scale of purple drank use is probably underestimated because its components “are easily available in pharmacies” (Psychiatria Danubina, 2025). South Africa fits that description: the ingredients sit on ordinary shelves and in ordinary bathroom cabinets.
What does lean do to you?
Lean makes the body heavy and slow. People describe a warm, floaty calm, then drowsiness, slurred speech and clumsy movement, which is where the name comes from: the drinker ends up leaning. The effect builds slowly, so people often drink more before the first cup has fully landed.
Side effects that families notice include nodding off in the middle of the day, itching, nausea, constipation, a dry mouth and a lot of sugary drinks going through the house. With regular use, the same amount stops working, sleep gets worse rather than better, and school or work starts to slip. Teeth suffer from the sugar.
Can you die from lean?
Yes. Codeine can cause “serious or life-threatening breathing problems” (MedlinePlus), and lean adds a second sedative on top, often with alcohol or sleeping pills as well. There is no safe home recipe, because syrups differ in strength and nobody measures.
If someone is “unable to respond or wake up” (MedlinePlus), has blue lips or is breathing very slowly, put them on their side and call 10177, or 112 from a cellphone, now.
Is lean legal, and can you buy codeine without a prescription in South Africa?
Some codeine syrups can be bought without a prescription, but only from a pharmacist. Codeine products are scheduled 2 to 6 depending on the dose and what else is in them (Spotlight via Daily Maverick, 2024). Schedule 2 and 3 products, “unless prescribed”, may only be sold by a pharmacist or a supervised assistant at a licensed pharmacy (SAHPRA).
So there is no special law against pouring syrup into a cool drink. What sits outside the rules is how the syrup gets there. SAHPRA says it is aware of “illicit sales of codeine-containing cough syrups through other outlets” (SAHPRA), and the rules on recording buyers keep getting tighter.
| When | What changed |
|---|---|
| 2017 | Regulations under the Medicines Act made it mandatory to capture the ID number of anyone buying a medicine scheduled 2 or higher |
| 2024 | New guidelines proposed so that every pharmacy and health provider digitally records the ID of anyone who buys or collects codeine |
| 2026 | SAHPRA describes lean use as having reached “epidemic” levels, and the stricter plan is reported to be implemented this year |
Sources: Spotlight via Daily Maverick, 2 May 2024; Business Day, 1 June 2026.
How common is lean in South Africa?
Common enough that the regulator calls it an epidemic (Business Day, 2026). In one survey of township schools, about a quarter of Grade 10 to 12 pupils said they had used codeine cough mixtures to get high (Spotlight via Daily Maverick). Very few of those teenagers ever reach a treatment centre.
The treatment figures show a different group. Over-the-counter and prescription medicines are the main drug for 1% to 3% of people entering specialist treatment, depending on the region, and their national average age is 37 (SACENDU, January to June 2025). Across all admissions, 4% of patients also reported using codeine medication, a rate that has fallen over the last three reporting periods.
Put the two together and codeine trouble in South Africa has two faces: the teenager with a purple bottle, and the working adult who has taken codeine painkillers every day for years and cannot stop, on the same drug.
Is lean addictive?
Yes. Codeine is an opioid, and with regular use the body adapts: the same cup does less, the person drinks more, and stopping starts to feel bad. The NHS warns against stopping codeine suddenly after long use because it “can cause withdrawal symptoms such as feeling agitated or anxious” (NHS).
Withdrawal feels like a bad flu with nerves on top: aching, sweating, a runny nose, stomach cramps, broken sleep and strong cravings. It is unpleasant enough that many people drink again just to make it stop, and that is how a weekend habit turns into a daily one.
The other half of the answer is what lean was doing for the person. For a teenager it may quieten anxiety, fill empty evenings or buy a place in a group. Adults on codeine painkillers often started for real pain and kept going for the calm. Take the codeine away without dealing with that, and the pull comes back on the first hard day.
What are the signs that someone is drinking lean?
The clearest signs are syrup bottles or cups with a purple or red residue, cough mixture disappearing when nobody is ill, and someone who is drowsy, slurring or nodding off at odd times. One sign alone means little. Several together, over weeks, are worth acting on.
What parents usually notice first
- Empty syrup bottles, sweet wrappers and two-litre cool drink bottles in a bedroom or bag.
- Requests for money for “cough medicine”, or trips to several pharmacies.
- Sleeping late, slow speech, glassy eyes, constant thirst.
- Constipation, itching and complaints about teeth.
- Marks dropping, friends changing, irritability when the supply runs out.
What should parents do if their child is drinking lean?
Stay calm tonight and act this week. Clear codeine medicines out of the house, check that the child is safe and wakes easily, and save the conversation for a clear morning. Then make one call to someone who treats this, before the habit hardens.
Four steps for the next few days
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Empty the medicine cupboard
Codeine syrups, codeine painkillers, sleeping tablets and alcohol: lock them away or take them out of the house.
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Talk when they are clear
Not while they are drowsy, and not in front of siblings. Our guide on how to talk to a loved one about rehab covers what to say first.
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Describe, do not label
“I found these bottles and I am worried about you” keeps the door open. “You are an addict” closes it.
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Message us, even if they say they can stop
We will ask what they are drinking, how much and for how long, and tell you whether a medical detox is needed. Our family support can start before anyone agrees to treatment.
How is codeine and lean addiction treated?
Treatment starts with a planned detox, so nurses and a doctor manage the withdrawal, and then moves to therapy that deals with why the person needed the codeine. At our centre in Lakeside, both happen in the same house with the same team.
Medical detox runs where it is clinically indicated, with 24-hour nursing supervision and a doctor who sees the person on site. Medication is used only when a medical professional prescribes it, and a psychiatrist selects it where needed. For codeine, that means the nursing team watches and eases the flu-like days. More on that first week: medical detox in Cape Town.
After detox, the day has a shape: up at 07:00, a morning group, a one-to-one session, groups until four, step work and a 12-step meeting every evening, and on Saturdays a hike, pottery or lunch in town. Ruby Weber, our psychologist, leads the psychological side of our dual diagnosis work, so the anxiety, low mood or trauma under the codeine is treated on the same plan. Drug tests on arrival and at random keep the house safe for everyone in it.
On the first call we ask what is being taken, how much and for how long. A clinical assessment follows within three days, and admission can be immediate. The fee depends on the programme and how long the person stays; we give it on the call and send it in writing the same day. You pay us directly, so no scheme cap decides when the person goes home. Every discharge includes a written relapse-prevention plan built for the home the person goes back to, and sober living and aftercare is there afterwards.
Renewed Life Center is in Lakeside, in Cape Town’s Southern Suburbs, close to Muizenberg beach, with the mountain ridge right behind the house. If lean is mixed with white pipe at home, our page on what mandrax is explains the other half of that picture.
Book a free, confidential call: 20 to 40 minutes by WhatsApp, video or phone, with no obligation.
What else do people ask about lean?
Usually purple, which is where the name purple drank comes from, but it can be red, pink, green or clear. The colour comes from the syrup and any sweets added, not from the codeine, so a pale drink can be just as strong as a dark one.
Yes. Lean, purple drank, sizzurp and dirty sprite are all names for the same thing: codeine syrup mixed with a soft drink. The name changes with the music, the town and the friend group, but the drug inside is the same opioid.
The drink itself is a mixture, but its active ingredient, codeine, is an opioid. That is why lean brings the same problems as other opioids: tolerance, dependence, withdrawal when stopping, and slowed breathing at high doses or when mixed with alcohol or sleeping pills.
Yes. Plenty of adults with codeine dependence never drank lean at all: they started on painkillers for a back, a migraine or a bad year and could not stop. Our medical detox and residential programme in Lakeside treat them exactly as they treat anyone else.
This article is general information, not medical advice.
Sources
- South African Health Products Regulatory Authority (SAHPRA): codeine-containing medicines
- South African Medical Research Council, SACENDU research brief Vol 29 (1), 2026: alcohol, tobacco and other drug use trends, January to June 2025 (PDF)
- Spotlight via Daily Maverick, Codeine misuse: South Africa set to get new guidelines (2 May 2024)
- Business Day, Stricter regulation of codeine products in the pipeline (1 June 2026)
- Daily Maverick, Purple menace: South African teens embrace codeine-fuelled DIY high (29 August 2022)
- MedlinePlus: codeine
- NHS: codeine
- Review of dextromethorphan and codeine/promethazine cough syrup misuse (2013), PubMed 24648790
- Review of purple drank use, Psychiatria Danubina (2025), PubMed 40982825
- Western Cape Government: know who you can call in an emergency
If codeine has a hold on someone in your house, start with one call.
A free first conversation, a clinical assessment within three days, and admission that can be immediate. We will tell you whether a medical detox is needed and help you arrange it.
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