Codeine and promethazine are both medications that are often combined together in a syrup form. This combination is typically referred to as “purple drank” or “lean” on the streets. The “yellow” distinction refers to the color of a specific manufacturer’s version of the syrup, as opposed to the more well-known purple color.
What is codeine?
Codeine is an opiate narcotic that is used to treat mild to moderate pain. It can also be used to reduce coughing. Codeine works by binding to opioid receptors in the brain and spinal cord, which blocks pain signals and causes a reduction in cough reflex.
Some common brand name codeine medications include:
| Brand Name | Form |
|---|---|
| Tylenol with Codeine | Tablet |
| Codeine Sulfate | Tablet |
| Fioricet with Codeine | Capsule |
Codeine is available by prescription either alone or in combination with other medications like acetaminophen or aspirin. It comes in immediate-release and extended-release oral formulations. The extended-release forms provide pain relief for a longer period of time.
What is promethazine?
Promethazine is a first-generation antihistamine medication. It is used to treat allergic reactions and symptoms like runny nose, watery eyes, itching, and skin rashes. Promethazine can also help reduce motion sickness and ease nausea and vomiting.
Some common brand name promethazine products include:
| Brand Name | Form |
|---|---|
| Phenergan | Tablet, syrup, injectable |
| Promethegan | Suppository |
| Phenadoz | Suppository |
Promethazine is available by prescription in oral tablet, syrup, suppository, and injectable solution forms. The injectable solution is typically administered intravenously or intramuscularly.
Codeine and promethazine combination
Codeine and promethazine are often combined together in a syrup preparation for the treatment of mild pain as well as cough and cold and allergy symptoms. The codeine provides pain relief and cough suppression, while the promethazine treats allergy symptoms, nausea, and vomiting.
Some common brand name codeine/promethazine syrups include:
| Brand Name |
|---|
| Phenergan with Codeine |
| Codeine and Promethazine |
| Cheratussin AC |
These syrups typically contain codeine (10-20 mg per 5mL) along with promethazine (6.25-12.5 mg per 5mL) in addition to other inactive ingredients that provide flavor and color.
What is “yellow” codeine/promethazine?
“Yellow” refers to one specific manufacturer’s version of codeine/promethazine syrup that has a yellow coloration rather than the more well-known purple color.
The yellow syrup contains the following in each 5mL:
- Codeine phosphate 10mg
- Promethazine hydrochloride 6.25mg
- High fructose corn syrup
- Glycerin
- Flavors
- Dye (yellow #10)
This yellow version is manufactured by Wockhardt Pharmaceuticals and distributed under the name Codeine and Promethazine Syrup. Other inactive ingredients provide the thick, syrupy texture and yellow hue.
Recreational use and abuse
While codeine/promethazine syrups do have legitimate medical uses, they are often misused recreationally for their psychoactive effects. The codeine provides a euphoric opiate high, while the promethazine potentiates the effects through its sedating properties.
Common street names for recreational use include:
- “Lean” or “Purple drank”
- “Sizzurp”
- “Syrup”
Abusers typically mix the syrup with soft drinks like Sprite or Mountain Dew, or alcoholic drinks. Some even freeze the mixture into popsicles for easier consumption. The yellow syrup may be preferred by some recreational users because of its novelty and distinction from the more common purple color.
Risks and dangers
Recreational abuse of codeine/promethazine syrups carries many risks including:
- Respiratory depression – especially at higher doses, codeine depresses breathing and can be fatal.
- Overdose and death – it is very easy to overdose on opiates like codeine.
- Drowsiness and sedation – impairment raises the risk of accidents.
- Nausea and vomiting
- Constipation
- Potential for dependence and addiction
Drinking the syrup with alcohol or other drugs increases the central nervous system depression and risk of severe side effects. Long term recreational use can lead to physical and psychological dependence on codeine.
Signs of codeine/promethazine addiction
Some red flags that can indicate someone is addicted to the codeine/promethazine syrup include:
- Drinking the syrup daily or almost daily
- Drinking more syrup or taking higher doses over time
- Experience withdrawal symptoms like restlessness, muscle/bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”) when stopping use
- Continuing to use despite negative physical or mental health consequences
- Excessive focus on getting and using more syrup
- Using the syrup in physically hazardous situations (i.e. driving)
- Hiding syrup use from others
- Changes in behavior and appearance, lack of motivation
Addiction is more likely with longer-term abuse. Psychological dependence can develop as users associate the high with relaxation and enjoyment. It becomes difficult to cope with daily life without the drug.
Treatment options for addiction
For those addicted to codeine/promethazine syrup, professional treatment and support can help overcome the substance use disorder. Treatment options may include:
- Medically supervised detox – To safely manage withdrawal symptoms during the detoxification period. This initial step gets the drug out of the system.
- Inpatient rehab – Short-term residential program provides a highly structured environment to focus solely on recovery.
- Outpatient programs – Less intensive programs with scheduled treatment sessions and more flexibility.
- Support groups – 12-step programs like Narcotics Anonymous provide peer support for maintaining sobriety.
- Counseling – Individual and group counseling helps identify triggers of addiction and develop healthier coping skills.
- Medications – Drugs like methadone, buprenorphine, or naltrexone can help ease withdrawal symptoms and curb opioid cravings during recovery.
A customized treatment plan can address both the physical and psychological sides of codeine/promethazine addiction. With professional help, even severe addiction can be overcome through dedication and lifestyle changes. It may be difficult, but a drug-free life is absolutely attainable.
Conclusion
Codeine/promethazine syrup preparations like “yellow syrup” may seem like harmless medicines. However, their misuse potential is high, and many individuals develop life-threatening addictions. Seeking professional treatment can break the dependence on these drugs. With support and hard work, recovering users can take back control and build healthy, fulfilling lives.
