Some know it as “lean,” some know it as codeine-promethazine and many don’t know it at all. Although blues musicians were mixing cough syrup and alcohol back in the 1960’s, that doesn’t mean they had a name for it. Nevertheless, the newest incarnation of this formula, also commonly known as “sizzurp” and “purple drank,” has continued through the decades and has left an indelible mark on the Houston hip-hop community, claiming many of its most celebrated figures along the way. Throughout its evolution, lean has undergone several ingredient changes and now consists primarily of alcohol, cough syrup, some type of soft drink and sometimes fruit-flavored hard candy.

Some of the more notable proponents of lean include Houston hip-hop innovator DJ Screw (who died of complications related to the drug and whose signature sound was often linked to it), Big Moe, Z-Ro. H.A.W.K, Three 6 Mafia and UGK. Big Moe died from a heart attack at 33 and, although his death was not directly attributed to codeine overdose, he was an avid consumer of lean. Another high-profile lean-related death occurred a short time after Big Moe’s when Houston hip-hop fixture Pimp-C passed away in his Los Angeles hotel room. Pimp-C’s death was the result of a combination of codeine-promethazine use and sleep apnea. Since then there have been a number of Houston rappers that have discussed their personal experiences with lean and the negative impact it’s had on hip-hop culture.

Some of the main effects of lean include lethargy, impairment of motor skills, decelerated heart rate, respiratory distress and more. Though its dangers have been well documented, lean is enjoying a younger and younger consumer base, particularly around the Houston area. A 2008 study found that 10 percent of American teenagers had abused cough syrup to get high. It is commonly used alongside simultaneously with other drugs. One of the more dangerous and immediate effects of lean is that its ability to depress the central nervous system, stopping the heart and lungs. This is an effect similar to the kind experienced when mixing alcohol and benzodiazepines.

There is increasing opinion that the dangers of lean should be thoroughly explained by the hip hop community and that a problem that started in Houston should be addressed there. Regardless of where one chooses place culpability in the proliferation of lean, the drug has proven to be one more in a series of deadly substance abuse threats facing the state of Texas.