Sizzurp, purple drank, lean -- that cough-syrup-laced concoction of many names -- has been gaining popularity in hip hop culture and notoriety as more celebrities fall prey to its effects. Rapper Lil Wayne was hospitalized at Cedars-Sinai last week, reportedly linked to use of the prescription-strength medication.
The codeine in the medicine serves as a pain reliever and also suppresses coughing, said Dr. George Fallieras, an emergency room physician and hospitalist at Good Samaritan Hospital. 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’s 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," Fallieras said.
But promethazine is a depressant of the central nervous system, Fallieras said. More importantly, codeine is a respiratory depressant, he added -- and when taken in very large amounts, it can cause people to stop breathing.
"A lot of times these guys are not just drinking the purple drink, they’re also drinking alcohol," Fallieras said. “And potentially in combination with alcohol and other drugs -- all of these together can be a lethal cocktail."
Lil Wayne reportedly suffered seizures as well, but Fallieras said that high doses of the drink would probably precipitate seizures only in patients who were already prone to them.
The so-called purple drank gains its name from the dyes in the cough syrup, which is mixed with a soft drink and perhaps a sugary candy for sweetness. It has become very popular, spreading through rap lyrics, and across state lines through Texas and Louisiana (where Lil Wayne hails from).
But codeine is an opiate – the same family of drugs as heroin and morphine -- and can be very addictive in high doses, Fallieras said. And promethazine has at least anecdotally been noted to intensify the euphoric effects of codeine in the brain.
"There’s a misconception that codeine is a weaker formula of the same class of medicine [as heroin]," Fallieras said. “But the amount of codeine these guys ingest with the syrup is massive … it’s just the same as someone being addicted to heroin, except they’re not using needles.”
Lil Wayne has spoken about the difficulty of overcoming a sizzurp habit, which did not surprise Fallieras, who described a withdrawal from opiates.
"One patient said to me, 'Imagine the worst flu when you’re shivering, you’re vomiting, you can’t eat, you have diarrhea, every atom in your body hurts, you can’t sleep, you lie on the floor just shivering … and multiply that times a million,'" Fallieras recounted. "And you know if you can just take the pill or inject yourself with heroin, that it just all goes away."
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