Sippin’ on Syrup: Codeine Drinks Can be Deadly

Purple Drank, Syrup, Lean, Sizzurp, Watson, Barre, Texas Tea.

“Kids need to understand, it’s a very addictive drug”

–– DJ Lil Randy, friend of the late hip-hop pioneer DJ Screw, who died after a Purple Drank overdose

Disciples of Southern hip-hop know it by many names:  Purple Drank, Syrup, Lean, Sizzurp, Watson, Barre, Texas Tea.

The practice of sipping codeine cough syrup that’s cut with soda and candy is not a new trend.  But Purple Drank and company is raising alarm with the deaths of several hip-hop artists, the arrests of NFL football players and the hospitalization of rapper Lil’ Wayne – all related to binges of codeine-promethazine cough syrup.

Now comes a plea from a protégé of the late DJ Screw – the hip-hop legend who popularized Purple Drank as a match for his woozy, slow-motion rap mixes.

“A lot of people don’t like to talk about the negative things about syrup – they’re just trying to make it stay cool, and it’s really not,” says Lil Randy, a childhood friend and longtime collaborator of DJ Screw. 

“Kids need to understand, it’s a very addictive drug.”

The two rappers often sipped Purple Drank together in the 1990s; DJ Screw died in November, 2000, following seizures from a mix of Purple Drank and other drugs.

“When you can’t sleep or you can’t eat – or your body can’t go through the day without needing syrup – you’re addicted to it,” Lil Randy says.  “Syrup is a heroin addict, syrup is a crackhead.  Any drug that you feel is the worst drug that you wouldn’t do, that’s what syrup is.”

A Toxic Cocktail, Now in Many Colors

Purple Drank contains prescription cough syrup with codeine (an opioid narcotic) and promethazine (an antihistamine).  Users typically add lemon-lime soda and hard candies for color and sweetness, and sip the beverage for hours, concealed in foam cups.

Dr. Peters“Everyone knows about codeine and promethazine in the South.  It’s almost like asking someone if you’ve ever heard of marijuana,” says Dr. Ronald J. Peters, who conducted studies on cough syrup abuse as associate professor of public health at the University of Texas Health Science Center at Houston.”

“It’s very addictive.  You can have an overdose, people have had what is called “syrup comas,”’ Peters says.  “There have been many under-reported accidents with kids trying to drive cars and actually falling asleep at the wheel because of this (codeine-promethazine abuse).”

Potential Brain Damage & Other Hazards

Purple Drank induces mild euphoria and a hypnotic state when taken in large doses (some abuse codeine syrup at 20 times higher than the recommended prescription dose).

Like a drunken stupor, sippers may exhibit slurred speech and impaired motor coordination (one nickname, “lean,” reflects the need to lean on something while high on the codeine drink).

Chronic use of sugar-laden Purple Drank can cause severe tooth decay, bowel and kidney problems.  Overdose can trigger seizures or death from respiratory failure or cardiac arrest – especially when Purple Drank is mixed with alcohol or other drugs.

Long-term brain damage is also a risk.  A recent study concludes that chronic abuse of codeine-infused cough syrup can alter the brain’s dopamine neurotransmitters and “may cause serious damage to the brain” (Haifeng Hou et. Al, published in “Drug and Alcohol Dependence,” November 1, 2011).

Off the Market:  The Purple Juice

Widespread abuse of codeine-promethazine led the pharmaceutical company Actavis to remove its signature purple syrup from the market in 2013.  Citing the “unlawful and dangerous use of the product,” Actavis said it would cease production of its codeine-promethazine drug, the preferred syrup for Purple Drank users.

The Actavis decision, Peters says, has sent prices soaring on the black market – with users paying $2,500 or more for a pint of Actavis syrup.

“The price going up really stopped it from being an endemic among kids,” Peters says.

There’s still a street market for the abuse of prescription cough syrup, although perhaps less desirable for Purple Drank users.

“There are at least three other sources of codeine-based cough syrups by prescription, and a man-made version called Watson.  They usually make it purple to mimic the traditional codeine-promethazine,” Peters says (Watson Pharmaceuticals acquired Actavis in 2012).”

Today, with Actavis’ purple syrup no longer being manufactured, sippers are turning to a red product made by Hi-Tech Pharmaceuticals, Inc., Peters says.  The red syrup contains codeine-promethazine and costs about $800 a pint on the street; a green version contains only promethazine and sells for about $200 a pint, he says.

“Real sippers sip on the red and because of the cost, usually kids and indigent addicts drink the green,” Peters says.

Moving Closer to Mainstream

Despite its potential harm – and the Purple Drank-related deaths of rappers DJ Screw, Big Moe and Pimp C – codeine sipping remains popular.  Songs such as “Sippin’ On Some Syrup” by Three 6 Mafia glamorize the drink, and professional athletes and rappers have been arrested in recent years for codeine possession.

“I would go into high schools and try to educate people about the problem,” says Peters, who recently retired from UT in Houston.  The challenge, he says, was to de-value a dangerous, illegal drug that had high social approval.

“You would have five or six kids drinking Sprite in a circle.  They would usually take two ounces of codeine and mix it with Sprite or Big Red, and put Jolly Ranchers or Skittles with the codeine.  When they got to a certain level of addiction, they would (add) more ounces of codeine.”
National usage of Purple Drank and its incarnations is difficult to establish, as most studies are focused largely on African American males in Houston.  In its 2013 “Emerging Trends” report, the National Institute on Drug Abuse says the practice of sipping narcotic cough syrup “has now become increasingly popular among youth in several areas of the country.”

One in eight U.S. teens has reported using over-the-counter cough medicine to get high, according to The Partnership at Drugfree.org (the key ingredient in over-the-counter medicine is dextromethorphan, as opposed to the narcotic codeine in Purple Drank).

A regional study of 2,349 college students in the Southeast found that 6.5% had used Purple Drank; consumption was most prevalent among Native American and Hispanic students.  Males, LGBT students and those from urban areas were also more likely to have used Purple Drank (Agnich et. al., “Purple drank prevalence and characteristics of misusers of codeine cough syrup mixtures,” Addictive Behaviors (2013).

Anti-Energy Drinks:  Gateway to Danger?

As cough syrup abuse continues, health experts have another concern:  the sale of legal “anti-energy” drinks that target the same youthful demographic.

With names like “Drank,” “Purple Stuff” and “Sipping Syrup,” the carbonated beverages piggy-back on the appeal of Purple Drank, Peters says – even though they do not contain codeine or promethazine.  Sold in convenience stores, the drinks produce a sedating effect with herbal ingredients such as melatonin.  Their marketing campaigns invoke hip-hop slang and lots of purple-hued graphics.

“They took the names from the street, then they created and branded drinks to “stroll your roll,” Peters says, citing one beverage slogan.  “It’s the worst example of corporate immorality that I’ve seen.”

“From the research that I did, we saw a connection between these quasi-drinks and kids actually using codeine promethazine — meaning these drinks were a gateway to using the real thing.”

Purple Drank in “Chopped and Screwed” Culture

The misuse of codeine cough syrup was first reported as a substance abuse trend in Houston in 1996, according to the Texas Commission on Alcohol and Drug Abuse.  Purple Drank became widely popular a few years later, as the inspiration for an innovative hip-hop style known as “chopped and screwed.”  The technique was pioneered by DJ Screw (a.k.a. Robert Earl Davis Jr.), the Houston rapper/producer whose sought-after mix tapes slowed the tempo to a lethargic crawl.

The Screw Tapes – which had a profound influence on hip-hop and electronic music – often invoked a codeine syrup buzz (Let’s Call Up On Drank, Sippin’ Codeine, Syrup and Soda, Codeine Fiend, Barre, Drankin’ On A Gallon, etc.)

“It kind of went hand and hand with the type of music Screw was doing,” Lil Randy says.  “Syrup slows you down because it’s filled with narcotics.  Around the time when we all started experimenting with syrup, Screw started experimenting with his music being slow.”

Lil’ Randy recalls the staggering personal consequences of using Purple Drank.

“I was doing a recording and we were up all night doing (codeine) syrup.  We might have drunk three to four pints of syrup, I might have drunk eight 2-liters of soda,” he says.

“I left and I just could not keep my eyes open while I was driving.  When I pulled up to a red light, I had completely fallen asleep.  When I woke up – from someone in back of me blowing their horn – I stepped on the gas and then I fell right back asleep and crashed into a pole.”

While he was serving time in prison for narcotics possession, Lil Randy learned of DJ Screw’s fatal overdose.

“I was in jail when he died. That was the worst feeling ever, to have your best friend pass on you,” he says.  “I couldn’t be there.”

Today, Lil Randy keeps DJ Screw’s legacy alive as the official DJ for the Screwed Up Click (SUC) hip hop collective.  But he says fans who want to get high on cough syrup are doing “the craziest thing ever” to harm their life.

Lil Randy feels his friend’s absence and laments that everyone, it seems, is trying to copy DJ Screw’s signature re-mixes.  There’s even a “Chopped & Screwed” app on iTunes.

“I feel like the music industry has a major hole in it without DJ Screw here,” Lil Randy says.  “There’s a million DJ Screws now.  It’s not original anymore.”

Resources for Parents, Help for Addiction

These support resources can help prevent the abuse of cough medicines (both prescription and over-the-counter), and start the recovery process for people with opioid addiction.

Help Hotlines

1-855-DRUG-FREE (1-855-378-4373)  Parent Helpline sponsored by The Partnership for Drug-Free Kids.

1-800-662-HELP (4357)  24-hour National Drug and Alcohol Abuse Hotline offering information and referral services to people seeking treatment and other assistance; sponsored by the Center for Substance Abuse Treatment (CSAT)

1-800-NCA-CALL (800-622-2255)  24-hour helpline sponsored by the National Council on Alcoholism and Drug Dependence.

Tools For Parents

http://stopmedicineabuse.org/tools-to-take-action/parents

A wealth of resources for parents, to help their teens make wise choices.  Includes ways to prevent cough medicine abuse and tips for talking to teens about drugs and alcohol.

http://www.dare.org/wp-content/uploads/2013/12/2513DARE_Teen-Medicine-Abuse-Flyer.pdf

Facts and resources on teen misuse/abuse of prescriptions and over-the-counter drugs.  Published by D.A.R.E. (Drug Abuse Resistance Education):

Help For Opioid Addictions

http://store.samhsa.gov/product/Medication-Assisted-Treatment-for-Opioid-Addiction-Facts-for-Families-and-Friends/SMA14-4443

Provides information on medication-assisted treatment for opioid addiction.  A free brochure from the Substance Abuse and Mental Health Services Administration.

http://www.drugabuse.gov/publications/seeking-drug-abuse-treatment-know-what-to-ask/introduction

Reviews questions to ask when searching for a rehabilitation program.  A free publication from the National Institute on Drug Abuse (NIDA).

http://www.drugrehab.org/

For More Information About Syrup Rehab Call Us TodayFree informative guides on addiction and recovery — including the Guide to Choosing the Right Rehab, which outlines best practices for treatment.  Drugrehab.org is an independent service, not funded by or affiliated with any treatment center.  To find help for opioid dependence, call 1-888-957-3422 (24/7).  All calls are confidential.

Mutual Aid/Support Groups

These websites include online forums, mutual aid organizations, 12-step programs and other support resources for people with addiction:

https://ncadd.org/recovery-support/mutual-aid-support

http://www.addictionsurvivors.org/

http://www.hbo.com/addiction/understanding_addiction/resources.html

http://www.facesandvoicesofrecovery.org/