1. Overview

1.1. Names

The term purple drank is a nod to its purple hue, as most cough syrups are purple in color, and drank is an informal term for a beverage, especially an intoxicating drink. Other names include sizzurp,^[1] lean,^[2] syrup,^[1] drank,^[1] barre,^[1] purple jelly,^[1] Texas tea,^[3] dirty Sprite,^[4] and Tsikuni.^[5]

1.2. Ingredients

Traditionally, the base for purple drank has been prescription cold medicine, specifically cough syrup, one that contains both promethazine and codeine, but over-the-counter cold medicine that lists dextromethorphan as the active ingredient has also been used, as it can produce similar effects and eliminate the need for a doctor's visit.^[6][7] To create a drinkable mixture, the cough syrup is combined with Sprite, Mountain Dew, or grape-flavored Fanta and is typically served in a styrofoam cup.^[8][9][9] A hard candy, usually a Jolly Rancher, may be added to give the mixture a sweeter flavor.^[10]

2. Effects

The physiological effects of purple drank on the user is to produce mild "euphoric side effects", which are accompanied by "motor-skill impairment, lethargy, drowsiness, and a dissociative feeling from all other parts of the body."^[9] Houston author Lance Scott Walker noted that the super-sweet combination of soda, cough syrup, and Jolly Ranchers provides a flavor and mouthfeel, which stays on the tongue for an extended duration. This phenomenon is often appealing to first-time users.^[11] Purple drank is often used in combination with alcohol and/or other drugs.^[9]

The cough syrup used in purple drank contains codeine and promethazine (not to be confused with the recreational use of dextromethorphan). Promethazine induces a liver enzyme (CYP2D6) that makes codeine much stronger than it is alone,^[12] somewhat like the glutethimide (Doriden) and codeine combination that was popular on the streets from the seventies up to the early nineties when glutethimide was discontinued by manufacturers. A number of deaths have been attributed to this combination.

2.1. Hazards

In an article following the hospitalization of the rapper Lil Wayne alleged to be related to purple drank, the Los Angeles Times spoke to physician and hospitalist Dr. George Fallieras on the hazards of the concoction. Fallieras stated that in its intended usage, "The codeine in the medicine serves as a pain reliever and also suppresses coughing. A second drug in the cough syrup, known as promethazine, is used as an antihistamine and commonly used to treat motion sickness and nausea. It is also a bit of a sedative—employed partly to keep people from drinking too much of the stuff. This is a very common cough syrup that, when taken in appropriately prescribed quantities, is quite safe."^[13]

Dangers arise in higher doses since promethazine is a depressant of the central nervous system (CNS), and codeine is a respiratory depressant. When codeine is taken in very large amounts, it can cause one to stop breathing.^[13] Using alcohol and other drugs alongside purple drank increases the chance of respiratory depression.^[13] Fallieras stated that the concoction does not cause seizures itself, but increases their likelihood in those susceptible to them.^[13] The drink includes a massive amount of the opiate codeine, which can be addictive in high doses, and Fallieras states that "promethazine has at least anecdotally been noted to intensify the euphoric effects of codeine in the brain."^[13]

The addictive nature of the drink means that trying to discontinue regular usage can bring about symptoms of withdrawal.^[13] In a 2008 interview with MTV News, Lil Wayne described the withdrawal as feeling "like death in your stomach when you stop. Everybody wants me to stop all this and all that. It ain't that easy."^[14]

Purple drank is confirmed or suspected to have caused the deaths of several prominent users. Respiratory depression is a potentially serious or fatal adverse drug reaction associated with the use of codeine, but mainly the danger lies in the much more potent and CNS-depressing phenothiazine-related antihistamine promethazine. This depression is dose-related and is the mechanism for the potentially fatal consequences of overdose: respiratory or cardiac arrest. As with most CNS depressants, mixing with alcohol greatly increases the risk of respiratory failure and other complications.^[15]

3. History

According to Houston-based author Lance Scott Walker, purple drank developed in that city around the 1960s when blues musicians would take Robitussin and cut it with beer. Later when wine coolers came onto the market, they substituted for beer.^[11] These blues musicians lived in Houston's Fifth Ward, Third Ward, and South Park neighborhoods and the practice was taken up by the generation of rappers growing up in the same parts of the city.^[11] In the 1980s and 1990s the formula changed to using codeine promethazine cough syrup, somewhat like the Glutethimide and codeine combination that was popular from the seventies up to the early nineties.^[11]

Professor Ronald Peters, also a Houston resident, points out that purple drank remained a local Houston phenomenon until the 1990s rapper DJ Screw released several tunes mentioning the drink in his mixtapes, which were extremely popular in the Houston area.^[11]

Walker holds that DJ Screw's music was particularly appropriate for Houston's climate. Due to the heat and expanse of the Houston area residents spent long drives in their cars, "the music that most appropriately complements that has always been the music of DJ Screw, it's slowed down—and when I say slowed down I mean he would record sessions in his apartment with rappers freestyling over beats and he would make these big mixtapes and then he would actually slow them down even further on his cassette recorder."^[11] DJ Screw's invoking purple drank in his lyrics and his use of slow tempos had caused his style to be characterized "[a]s if the song itself has taken too much codeine promethazine".^[11] Rappers outside of Houston soon adopted aspects of his style.^[11]

Walker points out that purple drank had never been stigmatized in Houston, but with the apparently purple drank-related early death of DJ Screw, the concoction became the focus of law enforcement in the Houston area with felony charges being applied for some aspects surrounding it.^[11]

3.1. Popularization

Houston producer DJ Screw popularized the concoction, which is widely attributed as a source of inspiration for the chopped-and-screwed style of hip hop music.^[16][17] The promethazine and codeine concoction first gained popularity in the underground hip hop scene in Houston,^[17] where musician Big Hawk said it was consumed as early as the 1960s and 1970s, becoming more widely used in the early 1990s.^[18] Because of usage by rap artists in Houston, it became more popular in the 1990s.^[19] Its use later spread to other southern states.^[16]

In June 2000, Three 6 Mafia's single "Sippin' on Some Syrup", featuring UGK, brought the term purple drank to a nationwide audience.^[20]

In 2004, the University of Texas found that 8.3% of secondary school students in Texas had taken codeine syrup to get high.^[16] The Drug Enforcement Administration reports busts involving syrup across the southern United States, particularly in Texas and Florida.^[16]

As of 2011, the price of purple drank in Houston is twice the price as it is in Los Angeles .^[19]

3.2. Notable Incidents of Use

DJ Screw, who popularized the codeine-based drink, died of a codeine–promethazine-alcohol overdose on November 16, 2000, several months after the video of Three 6 Mafia's single debuted.^[21]

Big Moe, a DJ Screw protégé whose albums City of Syrup and Purple World were based on the drink and who has been described as having "rapped obsessively about the drug",^[22] died at age 33 on October 14, 2007, after suffering a heart attack one week earlier that left him in a coma.^[23] There was speculation that purple drank may have contributed to his death.^[24][25]

Pimp C, widely influential Port Arthur, Texas, rapper and a member of rap duo UGK, was found dead on December 4, 2007, at the Mondrian Hotel in West Hollywood, California. The Los Angeles County Coroner's Office reported that the rapper's death was "due to promethazine-codeine effects and other unestablished factors." Ed Winter, assistant chief of the Coroner's Office, said the levels of the medication were elevated, but not enough to deem the death an overdose. However, Pimp C had a history of sleep apnea, a condition that causes one to stop breathing for short periods during sleep. A spokesman for the coroner's office said that the combination of sleep apnea and cough medication probably suppressed Pimp C's breathing long enough to bring on his death.^[22][26]

Fredo Santana, an American rapper who frequently made references to the drink in his music, died of a seizure on January 19, 2018. According to TMZ, he had been suffering from liver and kidney problems, which were believed to be the result of his addiction.^[27]

In September 2006, Terrence Kiel, a San Diego Chargers player, was arrested during practice for the possession with intent to sell prescription cough syrup for use in making the drink.^[16] Kiel was caught trying to ship a case of syrup to a friend via FedEx. Kiel was charged with two felony counts of transporting a controlled substance and three counts of possession for sale of a controlled substance.^[28]

On July 8, 2008, Johnny Jolly, a Green Bay Packers player, was pulled over in his car by the police for playing an excessive level of music in a nightclub parking lot. The officers found a Dr Pepper bottle in a holder next to two Styrofoam cups containing soda and ice. The officers said the cups and the bottle all emitted "strong odors of codeine"^[29] even though the codeine is odorless according to National Institutes of Health.^[30] The case was dismissed,^[31] but charges were refiled in December 2009 after the Houston Police Department acquired new equipment that allowed the police to test the evidence again. Jolly faced a possible maximum sentence of up to 20 years in jail, but as a first time offender he would be eligible for probation.^[32]

On July 5, 2010, former Oakland Raiders quarterback JaMarcus Russell was arrested at his home in Mobile, Alabama, for possession of codeine syrup without a prescription. He was arrested as part of an undercover narcotics investigation. Russell was booked into city jail and released soon afterwards after making his bail.^[33]

On March 15, 2013, Lil Wayne was hospitalized with seizures allegedly after taking the drug.^[34] Fellow rapper Birdman, however denied that the seizures were in any way connected to drugs.^[35]

On June 11, 2013, just days after being robbed at gunpoint in San Francisco, rapper 2 Chainz was arrested at Los Angeles International Airport on charges of possessing promethazine and codeine (the primary ingredients of purple drank) along with marijuana.^[36]

Mac Miller, who died of a drug overdose not involving purple drank, spoke openly of his addiction to purple drank.^[37]

4. Commercial Products

Several legal commercial products loosely based on the concept of "purple drank" are marketed in the United States. In June 2008, Innovative Beverage Group, a Houston, Texas-based company, released a beverage called "Drank". The commercial product contains no codeine or promethazine, but claims to "Slow Your Roll" with a combination of herbal ingredients such as valerian root and rose hips as well as the hormone melatonin.^[38][39] Similar "anti-energy" or relaxation drinks on the commercial market use the names "Purple Stuff", "Sippin Syrup", and "Lean".^[40][41][42]

4.1. Criticism

These commercial products have been criticized for their potential to serve as gateways to the dangerous illegal concoction.^[41][42][43] At a mental health conference in February 2010, Dr. Ronald Peters, Jr., of the University of Texas Health Science Center said of "Drank": "They're taking the name, and they're trying to market it to young people." He described the beverage as "the worst thing I've ever seen on the street since the making of candy cigarettes".^[43]