The escalating use of Over the Counter (OTC) Drugs in teenagers and young adults


What is Purple Drank?

“Purple Drank” is a trendy, sweet-tasting drink, that is made up of prescription-grade cough syrup, hard candy and soft drinks. It can lead to death in teenagers and adolescents.

Purple Drank, Lean, Sizzurp and Dirty Sprite are new terms to many parents and signal a gateway to a world of drug abuse.

Parents feel ill-equipped to deal with a synthetic drug culture in which they have minimal understanding. Teenagers, adolescents and young adults can quickly become dependant on the readily available and sometimes lethal mixture of codeine/promethazine based cough syrup, soda and hard candy. Addiction, Psychosis and even death may follow.

‘Purple Drank’, has been written about, rapped about and popularised by celebrities. ‘Lean’ is a well-published term on social media channels, which are populated by young people.

Used in social settings and enjoyed for the ease in which it can be purchased in pharmacies and created at home, Purple Drank promotes feelings of euphoria and disassociation.

It takes just 30-45 minutes to ‘Kick-in”, after drinking. The peak of the high, is usually after 1 or 2 hours, followed by 4-6 hours of ongoing and reducing feelings associated with the use of popular drink.

The nickname ‘lean’ comes from a noticeable effect in young people who drink, the sweet-tasting and highly addictive cocktail. Documented effects of the potent mixture include slurred speech and the ‘lean’ or slouch from which the drug derives its street drug name.


The long term effects of Codeine use in young people are similar to the use of other drugs in the opiate family. All are highly addictive.

Oxycodone, Morphine and Heroin are other opioids that can become drugs of choice for teenagers. While Codeine is seen to be less potent than its neighbours in the opioid family; addiction can occur quickly.

Lean or Purple Drank often contains more than 25 times the recommended dose prescribed for safe use.

Many teenagers believe that there is some safety to be derived from the use of over the counter medications. This false belief can lure them into a trap that can ultimately lead to death.

Trust in the safety of shop-bought medications along with social use with a like-minded peer group, desensitises young people to the risks involved.

Analyses of the perception of drug use in teenagers revealed that adolescents with drug-using peers, perceive drug use to be less harmful, involve less risk and are perceived to have fewer adverse consequences.

The use of substances in teenagers is seen as a way of fitting in, making friends and having fun in social situations. Young minds rarely appreciate the high risks and consequences. There is little doubt that adolescents underestimate the dangers of drinking large amounts of codeine mixtures. The sweet taste served on ice is deceptive.

The potency and associated risks are not understood.

Codeine is an opiate. Opiates are highly addictive.

Addiction and dependence

addiction in teens

What begins as fun and recreational use with friends can soon become an out of control reliance on substances, then used to prevent the unpleasant side effects of withdrawing. Addiction and dependence can follow.

Excessive use of Codeine can slow the heart rate and depress breathing. Recent research indicates that regular Codeine users have a 30% increase in symptoms associated with chronic depression and low mood. When mixed with alcohol, the effects are multiplied and increasingly hazardous.

In 2017, 7% of young people in 10th Grade had misused cough medicine in the previous 12 months.


Promethazine is an antihistamine.

Overuse can lead to numerous complications, including changes in blood pressure, changes in heart rhythm, hallucinations, seizures and difficulties in breathing.

Parents may also notice a decrease in school attendance or lower grades. This is often a concern for parents who contact us. Purple Drank is known to affect memory and motivation. Lean is known to cause drowsiness and lack of energy, together with a reduced interest in activities, hobbies and sports.

The side effects make learning and studying increasingly challenging, grades plummet, attendance becomes unreliable, leading to young people leaving education or being excluded or withdrawn from school. This is often the flashing warning light for parents and educators that something is becoming out of control.

Parents are often faced with the complicated situation of navigating the education system with a young person who has been excluded from school. This is usually at a critical time in the educational calendar. IGCSE, GCSE, A-Level or IB attendance has frequently been sporadic, with behavioural changes that impacted performance, leading to questionable references for future schools.

The potential impact on completing the syllabus leads parents to look at options including online education, which can further complicate the issues of depression, isolation, anger, family tension, potential drug availability and use at home.

Sizzurp, Purp, or lean is very popular among students. This is partially due to availability and the low costs involved. Studies also indicate that it is more popular with teenage boys, together with adolescents that have experimented with other drugs; including cannabis.

Cannabis use

purple drank walls

Cannabis or Marijuana use in teenagers is increasing, along with concealed use in Vapes, Dabbing, Edibles and traditional using methods. (“Purple Drank Breathe”, while partially using the same street drug name; is an Indica/Sativa plant and member of the cannabis family).

Parents who suspect substance use are usually incredibly fearful, often shocked, angry, sad and disappointed. They typically explain that drug use is destroying family relationships, causing tension, worry and fear.

Many have become victims themselves of theft and violence in the home, unpleasant verbal assaults and feel unable to live a normal family life.

They have often tried talking, shouting, reasoning and pleading—ineffective consequences – grounding, reducing funds and increasing supervision.

A familiar theme in our first appointment is a lack of hope that anything can change.

Young people caught in a cycle of drug use can feel that they have no way out. The ups and downs of the usual teenage challenges are magnified; the risks are higher and the isolation greater. It is at this point that they need help.

Treatment options that remove young people from both the drug-using environment and circles of drug using friends are incredibly beneficial.

While travelling to treatment can feel like an enormous task when resilience and energy are at an all-time low; it affords the break in the patterns that young people and families need to build a sustained recovery.

Fiona Yassin is the Clinical Director of The Wave Clinic in Kuala Lumpur. Fiona is a Member of The Federation of Drug and Alcohol Professionals, A Certified Child and Adolescent Trauma Professional and a Fellow of ACCPH.

A member of NADDAC and Australia and New Zealand Mental Health Association. An Accredited Clinical Supervisor with over 15 years of experience in the specialist area of mental health and addiction.

Currently undertaking advanced CEDs training, Fiona has an interest in Eating Disorders in Young People, is D.B.T trained and utilises CBT-e in clinical settings. 

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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