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Lean: South Africa’s codeine addiction

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An estimated 600,000 South Africans are addicted to this opiate, often disguised in soft drinks and promoted by rappers and singers.

“Lean” or “double cupping” is the lingo used on South African streets, but also by rappers around the world. It refers to the drinking of Codeine, an opiate used to treat pain and found mainly in pain pills and cough syrups. Experts estimate that as many as 600,000 South Africans could be addicted to this “purple drink”, which is the combination of cough syrups and sugary drinks. Excessive amounts of codeine can have shocking effects on one’s health.

Codeine is a prescription pain medication used to treat mild to moderate pain. It comes in tablet form and as the main ingredient in prescription-grade cough suppressants. Tylenol 3, another popular pain reliever, is codeine combined with acetaminophen.

Codeine is an opiate (sometimes called a narcotic). Other opiates include oxycodone, heroin and morphine. Street names for codeine include cough syrup, schoolboy, coties and t-three’s.

The effects of codeine include:

  • Euphoria
  • Apathy
  • Drowsiness
  • Relaxation

As an opiate, codeine runs a high risk of its users developing a tolerance and eventually a dependence on it. Although many people begin using codeine to relieve a legitimate condition, it is frequently abused as tolerance develops. Many codeine users begin to turn to the drug to cope with all of their physical pain and eventually their emotional pain as well.

Although some people think the drug seems harmless, at high enough doses, codeine use can lead to respiratory failure, coma, and even death. This risk is especially high when codeine is combined with other central nervous system depressants such as alcohol or other opioids.

Codeine cough syrup is used to make “purple drank.” Purple drank is a recreational form of the drug made by mixing prescription-grade (codeine) cough syrup with soft drinks, such as Sprite or Mountain Dew, for consumption in large doses. It is also called lean, syrup and sizzurp.

Alarmingly glorified in popular culture, purple drank has been referenced throughout multiple songs and TV shows. It is mentioned in songs by artists like Lil’ Wayne and Three 6 Mafia.

Rapper Lil’ Wayne was admitted to the intensive care unit in March 2013 with seizures and unconsciousness caused by extremely high levels of codeine. Though he survived, he was in critical condition after having his stomach pumped three times to remove the drug from his system.

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