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Once an underground drug trend of the 90s, cough syrup abuse continues as part of the larger prescription drug abuse problem among teens. Today’s teens are getting high on cough syrup containing one of three mind altering ingredients: codeine, dextromethorphan (DXM), and promethazine (used in combination cough syrups).

Often referred by teens as “lean”, “barre”, “player potion”, “purple stuff” or “syrup”, the latest trend involves a drink which usually contains the prescription codeine/promethazine hydrochloride cough syrup (CPHS), soda, and a jolly rancher candy.

Accessibility

While a legal drug, codeine still requires a prescription which should make it harder for teen to access. However, thanks to the Internet, today’s teens have no problem scoring the prescription cough syrup through online pharmacies that don’t always require a verified prescription or by getting an over-the-counter version such as Robitussin DM which contains the active ingredient dextromethorphan (a hallucinogenic when used in high quantities). Teens are also getting their hands on it illegally through underground dealers sometimes referred to as syrup houses (DEA Communicator).In addition, real-time websites like myspace.com and Youtube.com post blogs and videos depicting the use of lean.

Scope of the problem

The scope of the problem is somewhat unclear because most surveys of drug trends don’t ask about it, but we do know that is an increasing problem and one educators, parents, and schools should know about. A 2004 survey by the University of Texas found that 25 percent of at-risk Houston youth have reported recreational use of codeine syrup, with 10 percent reporting that they used it within 30 days of being asked about it, according to the study (Journal of Drug Education). “Leaning” was made popular by a popular musician DJ Screw who died of an overdose of codeine cough syrup in 2000, through his re-mixed and slowed-down rap songs that reflected the narcotic effects of syrup. Since then many other rappers including the popular group Three 6 Mafia have written and produced songs about cough syrup abuse, the most recent, a song called “Sippin’ on Syrup.” These songs known by the genre, “Screw”, only serve to glorify this type of drug abuse and have created a social norm about their use. Many teens feel they are addicted on the first try and report an intense peer pressure to continue to use it (Journal of Drug Education).

Effects on the User

Codeine is a narcotic in the opiate family (the same family as heroin), derived from opium that is used for pain management and also acts as a cough suppressant. Teens who abuse it report feelings of euphoria and motor skill impairment. The slang term “lean” comes from the effect of the syrup to make the user lean over. The promethazine in cough syrup is used as a powerful antihistamine that has sedative properties making the user feel relaxed and calm. Overdosing on prescription syrup is potentially fatal. Too much codeine, which is produced from morphine, can depress the central nervous system and stop the heart and lungs.

Teens who use other types of cough syrup that include DXM have varied experiences depending on the amount but many report hallucinations, “out-of-body" dissociative sensations, and loss of motor control. Users often feel confusion, dizziness, double or blurred vision, slurred speech, loss of physical coordination, abdominal pain, nausea and vomiting, rapid heart beat, drowsiness, numbness of fingers and toes, and disorientation.

It’s important to note that cough medicine also is sometimes abused in combination with other medications, alcohol and other drugs (legal and illegal), which can increase the dangerous side effects.

What Can You Do?

Educate teens about the dangers of misusing prescription and over-the-counter cough medications.
Challenge the misperception that just because it’s legal, doesn’t make it safe.
Know the signs and symptoms of drug use and how to intervene if you suspect a problem.

The following tips come from Parents. The Anti-Drug, an online source of information for parents and teens on drug abuse. Share these tips with your students’ parents by hosting educational seminars, via letters home, and by posting them on your school’s website.

1. Reduce accessibility.
2. Avoid overstocking cough syrup and take inventory of your medicine cabinet.
3. Monitor Internet use.
4. Be aware of what type of music your teen is listening to.
5. Be aware of possible signs of abuse such as empty bottles in your teen’s room or bag.

For more information, please visit the Children of Alcoholics Foundation, www.coaf.org; the American Council for Drug Education,www.acde.org or Phoenix House, www.phoenixhouse.org. For specific program information geared toward older adolescents and college students visit the Facts on Tap Web site at www.factsontap.org.

REFERENCES

DEA Diversion Communicator. Accessed at: http://www.deadiversion.usdoj.gov/pubs/nwslttr/spec2000/texas.htm. Accessed on 11/2/06

Beliefs And Social Norms About Codeine And Promethazine Hydrochloride Cough Syrup (Cphcs) Onset And Perceived Addiction Among Urban Houstonian Adolescents: An Addiction Trend In The City Of Lean, , R. J. Peters, JR., Dr.PH, MS, S.H. Kelder, MPH, PH.D, C. M. Markham, PH.D, MA, et al., Journal of Drug Education. 33(4).2003 pp.415-425

Parents. The Anti-Drug. Accessed on: 11-2-06