Muir Wood therapist, David Laing

Codeine (“Purple Drank” or “Lean”)

“That Zan With That Lean”: Adolescent Substance Abuse and the Rap Culture


The current opioid crisis has received much attention in the United States. According to government data, more than 47,000 people were killed by opioids in 2017. Across 52 areas in 45 states opioid overdoses increased by 30 percent from July 2016 through September 2017. 

The focus of the authorities and the media typically homes in on prescription pain relievers containing oxycodone or hydrocodone, as well as the deadly synthetic opioid fentanyl or the more traditional heroin.

An opioid that largely remains under the radar is codeine. Unfortunately, it is widely misused by adolescents in the form of so-called “purple drank” or “lean.” Lean is a homemade concoction of codeine (as contained in many cough medicines), a soda like Sprite or Mountain Dew, and Jolly Ranchers, typically sipped out of a double-stacked styrofoam cup. Many young people are completely unaware that codeine is an opioid that belongs to the same class of drugs as heroin. 

Lean has been around since the early 1990s when Houston rappers such as Pimp C of UGK (who later died from complications caused by drinking it) and DJ Screw began to popularize it among the fans of their music, reported Lauren Levy on DJ Screw developed “chopped and screwed” music, in which he remixed albums to the slowed-down rate of about 60 beats per minute, which synced perfectly with the high produced by drinking lean. “As the influence of Houston’s rap scene grew, so did the popularity of the drink. When Lil Wayne came to national prominence, he brought lean with him.”

The concoction is not as harmless as many teenagers think. It is possible to imbibe dangerous amounts of codeine when using purple drank, resulting in an opioid overdose and even death. If the use of the drink is combined with alcohol or other drugs, the risk of severe harm increases. One such combination popular in the rap scene is taking the benzodiazepine Xanax (alprazolam) while sipping lean at the same time. Like lean, “benzos” are very much part of the rap culture idolized by many teenagers and young adults in America. “Much like the connection between heroin and grunge rock, Xanax rose to prominence alongside the subgenre of emo-meets-hip-hop called SoundCloud rap, named for the online platform favored by its most prominent artists,” wrote Levy in the Vulture article.   

Another cold remedy frequently misused by adolescents is so-called Triple C. That’s a slang term for Coricidin HBP Cough & Cold, a popular brand of cough and cold medicine often abused by teens. Several Coricidin products contain the cough suppressant dextromethorphan, a medication that can produce hallucinations and dissociation when taken in high doses. Triple C is often used by teens looking for a quick high.

“The rap community and its culture are definitely influential on those kids,” says Ian Cooper, residential program manager at Muir Wood. “The rappers use a lot of derogatory language and drug references in their songs, everything is about Xanax and lean, and the kids look up to those guys. The deaths of these musicians just gets glossed over, teenagers don’t look at the risk at all, they just look at it as fun. I think it goes back a long time to Kurt Cobain—more my era—kids idolizing those people. Even gun violence is glamorized and glorified through their music and becomes something to boast about.”

Death is definitely part of the scene. The rapper Lil Peep fatally overdosed on fentanyl and Xanax in November 2017. His frequent use of a variety of illicit drugs was driven by mental health issues. The drug use of rapper Mac Miller was also largely driven by co-occurring mental health conditions. He died in 2018 from an overdose due to the mixed drug toxicity of fentanyl, alcohol, and cocaine. Miller had spoken openly about his struggle with substance use and depression. To manage stress during his 2012 tour, Miller began using promethazine—an antihistamine often contained in allergy and cough medicine—and later became addicted to purple drank. 

These two cases are symptomatic of the addiction problem plaguing young people in America’s rap culture. Adolescents with mental health problems like anxiety, depression, or unprocessed trauma seek solace from emotional pain by following the lead of celebrities in their subculture. If rappers pose with double cups in their videos and are in “that Zan with that Lean” (song lyrics), it creates a desire to be as cool as those guys and do the drugs they’re doing. After all, what harm can sipping a little bit of soda with cough syrup really do? 

Quite a bit as it turns out—especially to people with a genetic predisposition for addiction, a lot of emotional stress,  and untreated mental health issues such as trauma, anxiety, and depression. Both Lil Peep and MacMiller escalated their substance misuse to hard drugs and alcohol which eventually killed them while they were still in their twenties.  

Muir Wood provides residential treatment for teenagers ages 12–19 in a gender-specific environment. Many of our patients have misused marijuana, alcohol, benzodiazepines, and codeine in an effort to deal with underlying emotional issues. Everything we do in our residential treatment program is designed specifically for the male gender and administered in an environment that includes only male patients. By treating only teenage teens, we eliminate the drama and distraction that is very common in teen rehabs that treat both teens and girls. In this gender-specific situation, our teens are free to focus on the important work and studies required to achieve a successful treatment outcome.