Prescription cough syrup containing codeine is legal only when prescribed by a licensed provider. Recreational use or possession without a prescription is illegal.

Understanding Addiction

What Is Lean? Understanding This Dangerous Opioid-Related Drug Trend in Tennessee

Name: Nashville Addiction Clinic
Price range: $$$

Posted by

Steve Tana

On February 25, 2026

0 comments

What is lean? Lean is a dangerous recreational drug mixture that typically contains prescription-strength cough syrup with codeine and promethazine, mixed with soda and sometimes candy. While it may seem harmless or “trendy” online, lean can be addictive, life-threatening, and closely tied to opioid misuse across Tennessee.

At Nashville Addiction Clinic, we treat adults ages 18–65 across the state — including Murfreesboro, Franklin, Jackson, Johnson City, Bartlett, and Hendersonville — who are struggling with opioid addiction in many forms. Lean is one of them.

If you or someone you love has been using lean, here’s what you need to know.

Addiction Treatment for Tennessee by Tennesseans in Recovery

Nashville Addiction Clinic provides evidence-based Suboxone treatment through secure telemedicine, staffed by licensed Tennessee clinicians. No clinic visits required, ever.

Statewide access across Tennessee
Accredited by The Joint Commission
Owned and managed by people in long-term recovery

Register for treatment online using your TennCare Medicaid, commercial insurance, or choose a payment plan. (A sliding-scale program is also available) Click here if you’re a returning patient.

What Is Lean Made Of?

To fully understand what is lean, it helps to break down its ingredients.

Lean (also called “purple drank,” “sizzurp,” or “dirty sprite”) usually contains:

Codeine cough syrup (an opioid)
Promethazine (an antihistamine that causes sedation)
Soda (often fruit-flavored)
Hard candy (sometimes dissolved into the mixture)

The key addictive ingredient is codeine, which is classified as an opioid. According to the U.S. Drug Enforcement Administration, opioids act on the brain’s receptors to reduce pain and produce feelings of relaxation or euphoria.

When combined with promethazine and soda, the sedating effects are amplified.

Why Is Lean So Dangerous?

When people ask, “what is lean?” they often assume it’s mild because it starts as cough syrup. But that assumption can be deadly.

1. Codeine Is an Opioid

Codeine is chemically related to morphine and heroin. Repeated use can lead to:

Physical dependence
Tolerance (needing more for the same effect)
Withdrawal symptoms
Opioid use disorder

According to the FDA, misuse of opioid medications increases the risk of overdose, especially when mixed with other depressants.

2. Respiratory Depression

Lean slows breathing. High doses — especially combined with alcohol or benzodiazepines — can cause:

Dangerous sedation
Slowed or stopped breathing
Brain injury
Death

3. Gateway to Stronger Opioids

Many patients at Nashville Addiction Clinic tell us their opioid use started with:

Prescription pain pills
Codeine cough syrup
Recreational experimentation

Over time, tolerance increases. When codeine no longer works, some transition to:

Oxycodone
Percocet
Hydrocodone
Fentanyl
Heroin

That progression happens more often than people realize.

What Does Lean Feel Like?

Understanding what is lean also means understanding why people use it.

Lean typically causes:

Relaxation
Euphoria
Drowsiness
Slurred speech
Slowed movement
Mental fog

But these short-term effects come with long-term risks.

People using lean regularly may experience:

Chronic constipation
Hormonal disruption
Depression
Anxiety
Memory problems
Severe withdrawal symptoms

Purple Drank, Sizzsurp, Barre — Lean’s Many Nicknames

“Lean” is a slang term, along with many other street names:

Purple Drank
Purple Stuff
Sizzurp / Syrup
Dirty Sprite
Barre
Texas Tea
Wock / Wocky
Act (from Actavis brand cough syrup)
Tussin (from Robitussin-type syrups)
Mud
Oil

Why the “Purple” Reference?

Many codeine-promethazine syrups are dyed purple, which is why the drink is often described that way in music and pop culture.

Lean Withdrawal: What to Expect

Because lean contains codeine, stopping suddenly can cause opioid withdrawal symptoms, including:

Muscle aches
Sweating
Nausea
Diarrhea
Insomnia
Anxiety
Intense cravings

While opioid withdrawal is rarely life-threatening, it is extremely uncomfortable — which often drives people back to using.

This is where medically supervised treatment becomes essential.

How Suboxone Treatment Helps If You’re Addicted to Lean

If you’ve been wondering what is lean because you or someone close to you is struggling, there is hope.

Suboxone (buprenorphine/naloxone) is an FDA-approved medication used to treat opioid use disorder. It works by:

Reducing withdrawal symptoms
Decreasing cravings
Blocking the effects of other opioids

At Nashville Addiction Clinic, we safely transition patients from:

Codeine
Hydrocodone
Oxycodone
Morphine
Fentanyl
Heroin
Methadone
Kratom
7-OH products

Suboxone allows the brain to stabilize without the intense highs and lows of opioid misuse.

Why Telemedicine Makes Recovery Possible Anywhere in Tennessee

Many people in rural Tennessee — whether near Centerville, Cleveland, Brentwood, Columbia, Cookeville, or outside LaVergne — struggle to access in-person addiction treatment.

Why do people trust Nashville Addiction Clinic with their online addiction treatment?

Accredited by The Joint Commission
Our clinic owners are in long-term recovery
Over 260 Google Reviews (from real patients)
Recipient of Tennessee’s first Virtual OBOT medical license
Same-day Suboxone prescriptions
Statewide award winner of the 2025 Best of Tennessee award for substance abuse treatment
Over 1000 patients served since 2019
Accepts most commercial/employee health plans, such as Blue Cross Blue Shield (all U.S. states), Cigna, Ambetter, and United Healthcare, as well as all TennCare Medicaid plans: Amerigroup Community Care, BlueCare, United Healthcare Community Plan, and Wellpoint Community Care.
Overnight Suboxone delivery is available in most areas (a delivery fee applies)
A compassionate team of caring doctors, nurse practitioners, counselors, and administrators who provide judgement-free care, some who are in recovery.
Same-day appointments available every Monday through Friday from 8:00 AM to 5:00 PM (based on availability)
Evening appointments every Monday and Wednesday until 9:00 PM

Our helpful staff is happy to answer any questions you may have. Call us or send us a text at (615) 927-7802, or message us securely using the Spruce Health mobile app.

Feeling nervous about starting telemedicine addiction treatment? Learn what to expect during your first Suboxone telemedicine appointment.

Tired of Visiting Clinics and Pharmacies? You Don’t Have to Anymore

We know the frustrations and stigmas often associated with addiction treatment, as well as the time it takes to visit a clinic, sit in a waiting room with people you don’t know, wondering if you’re being judged, watching the clock in hopes of leaving within a few hours. Sadly, your day doesn’t end there. You then have to drive to a pharmacy to pick up your Suboxone medications, which can sometimes be met with judgement, stigma, embarrassment, and even rejection.

By utilizing our Suboxone telemedicine program and overnight medication delivery pharmacy partner, you’ll never have to visit a clinic or pharmacy again.

What to Expect When Starting Treatment

Starting is simple:

Step 1: Register Online

Choose the option that fits you:

Register for Suboxone Telehealth using your TennCare Medicaid
Register for virtual Suboxone addiction treatment with your commercial insurance
No Insurance? Register for Suboxone Telemedicine therapy and make payments
Register as a returning patient
Apply for our Sliding-Scale Program
View all Medicaid and commercial insurance plans we accept and self-pay pricing
We accept most private/employee health insurance, such as BCBS, Cigna, Ambetter, and United Healthcare, as well as all TennCare Medicaid insurance: Amerigroup Community Care, BlueCare, United Healthcare Community Plan, and Wellpoint Community Care.
Same-day appointments and Suboxone prescriptions are often available when fully-registered before 10:00 am Central Time. (based on availability)

Not sure if your insurance is accepted? Click here to verify your coverage.

Experience a safe transition from hydrocodone, oxycodone, OxyContin, heroin, fentanyl, methadone, morphine, Kratom, 7-OH (7-Hydroxy-opioids), Norcos, Percocet, Roxicodone, Vicodin, Tianeptine, Tramadol, Opana, codeine, oxymorphone, and other opioids.

If you would like to speak to someone about our telemedicine Suboxone program, please call or text us at (615) 927-7802. You can also message us securely on the Spruce Health mobile app.

Step 2: Attend Your Video Appointment

Our master’s-level counselors and medical providers meet you privately, without judgment.

> Meet our supportive staff

Step 3: Receive Same-Day Medication

Your Suboxone prescription is sent to your pharmacy — often the same day.

Frequently Asked Questions About Lean

Is lean the same as heroin?

No, but both are opioids. Lean contains codeine, which is weaker than heroin but still addictive.

Can you overdose on lean?

Yes. High doses — especially combined with alcohol or other depressants — can cause fatal respiratory depression.

Is lean legal?

Prescription cough syrup containing codeine is legal only when prescribed. Recreational use is illegal.

Can Suboxone treat codeine addiction?

Yes. Suboxone is effective for opioid use disorder, including codeine dependence.

Does TennCare cover Suboxone telemedicine?

Yes. Nashville Addiction Clinic accepts TennCare for qualifying patients.

You Don’t Have to Hide or Handle This Alone

If you’ve been asking “what is lean?” because you’re worried about your own use, you are not weak — you may be dealing with opioid dependence.

Addiction is a medical condition, not a moral failure.

You can review insurance and pricing details before scheduling, so there are no surprises.

If you have TennCare Medicaid insurance, your treatment and medication costs are typically $0. If you have commercial health insurance, we will provide you with a treatment cost estimate before scheduling your first telemedicine appointment. If you don’t have health insurance, we offer biweekly and monthly payment plans.

Recovery is possible — and it can start today, privately, from anywhere in Tennessee.

Kratom (7-OH, 7-Hydroxy) Addiction is Rampant in Tennessee

If you’re struggling with Kratom addiction or products containing 7-hydroxy (7-OH), you are not alone. Many people across Tennessee have experienced severe withdrawal symptoms, cravings, and loss of control after using these highly potent substances.

There are growing reports that certain Tennessee retailers have provided free samples of Kratom and 7-Hydroxy products, a practice that raises serious concerns about intentionally encouraging dependence and repeat sales.

Recovery Care of Columbia has extensive experience helping patients safely transition from Kratom and 7-hydroxy products to buprenorphine/naloxone (Suboxone) through secure telemedicine appointments. Since 2024, we have treated hundreds of Tennesseans seeking relief from Kratom dependence—including individuals using daily amounts in excess of 800 mg.

Our providers understand the unique withdrawal patterns associated with 7-hydroxy and Kratom extracts. We develop personalized induction plans designed to reduce discomfort and stabilize you safely, without ever stepping into our clinic.

If you’re ready to stop Kratom, 7-OH, 7-Hydroxy, confidential online treatment is available now—no matter where you live in Tennessee.