The Worrying Rise of Lean in the UK

"Lean comas" and kidney failure are some of the lesser-known side effects of purple drank.
August 27, 2021, 8:13am
An illustration of lean and a bottle of cough syrup
Image: Owain Anderson

When Ethan first started sipping lean in 2015, it didn’t seem that much of a big deal for the then 16-year-old Londoner. The high was never intense, if it could be called a high at all. It was just a weird mix of things. Like being drowsy and tired, but still kind of up at the same time. 

Before long, it was a regular part of his day. And it was simple enough to make at home with a prescription cough syrup, or a suitable equivalent bought online, mixed with antihistamines and a soft drink of choice. 


Over the next five years, Ethan – whose name has been changed to protect his identity – managed a couple of month-long breaks before falling back into old habits. Soon there were other effects to contend with. First came the blood, flecked with urine and vomit. Things eventually came to a head with severe stomach and back pains, which turned into a stint in hospital with suspected kidney failure. 

Until recently, lean was considered a predominantly US-based phenomenon, with its roots in the South Houston hip-hop scene of the early 90s. The intervening years saw it spread across the States, popularised by generations of rappers from Lil Wayne to Mac Miller and aided by its cheapness and ready availability.

Its increasing popularity in the UK hasn’t gone unnoticed. Back in 2019, The Times ran a short piece on how teens – like Ethan – across the country were making their own purple drank via a combination of cheap cough syrup purchased online and YouTube tutorials. But anecdotal evidence suggests usage has only accelerated in the intervening years – a situation that has caused growing concern amongst youth workers and drugs charities. 

UK lean isn’t exactly the same as its US counterpart. For one thing, over-the-counter codeine medicines aren’t as readily available here as they are over the Atlantic. But the effects are the same – there’s the mixture of drowsiness and gentle euphoria, plus mild hallucinations and bodily dissociation, similar to ketamine


It’s also highly addictive. Though “cough syrup” sounds harmless, codeine is an opiate responsible for 212 deaths in 2020, according to the most recent ONS figures – a number that has doubled over the last decade. Though commonly prescribed by doctors, the danger comes when opiates are mixed with alcohol or other substances. There are other grim side effects, as Ethan can attest. Among the common ones reported are disrupted sleep, constipation, memory loss and often nasty withdrawal symptoms. 

It’s hard to say exactly when lean hit the UK, or to find reliable figures for the numbers of young people using it recreationally. For now, it remains trapped just out of reach of the world of surveys and academic study. Back in 2015, it wasn’t something Ethan had seen around that much, outside his local area. This was before British rappers like Ard Adz and Young Adz made regular reference to it in their music. But trends can accelerate, seemingly overnight. Over the past few years, he says he’s witnessed a definite growth in usage among his wider peers, as well as noticeable price hikes. 

“When I first started it was £50 for a full bottle [of cough syrup] and Phenergan [an antihistamine]. But [as it became] more popular, the price started rising and rising, and now it's between £170 to £200,” he says. 


It’s a story echoed by others, who bemoan the steeply rising costs involved with sipping lean. Still, access is easy enough if you have the funds. “You can order it from the pharmacies online; it's straightforward to get,” Ethan explains. “That's how I was getting it all the time. But people sell it in bulk. It must be distributed in size by some big company. But you have to be secretive about it.” 

Aaron – whose name has been changed to protect his privacy – was 18 when he first came across lean through a mutual friend in Leeds. He’d never been into uppers and the mellow high went together well with his heavy weed smoking. The guy he was getting it from made his own, good quality stuff and, Aaron stresses, it never became too regular a thing. “I’ll still [occasionally] schedule a little trippy one if I’m off work,” he tells VICE. “I don’t know about other people – I must know about ten of us who drink it.” 

Over the last year, Aaron usually combines lean with a bar or two of Xanax. It helps, he says, boost “the waviness of the body high”. Though he dismisses his own personal risk, it’s a potentially dangerous combination. Xanax, real or otherwise – has been on the well-documented rise across the UK over the past decade. Combining it with lean only increases the potential for harm. 


Gen Z aren’t quite as abstemious as reports have suggested. In February, UCL published the results of the Millennium Cohort Study, which explored drug and alcohol use amongst young people born between 2000-2002. Their findings suggested that one in ten 17-year-olds had used hard drugs. For some, it’s a time of natural experimentation – an age-old part of the teenage experience. For others, the start of something more concerning, with long-term effects. 

Kusai Rahal is Head of Youth Support at the 4Front Project, a member-led youth organisation in North West London supporting young people with experiences of violence and the criminal justice system. He explains that the rise of lean in the UK requires a more nuanced approach, rather than simply blaming music artists like Future and Lil Baby. “It's easy to point to [one thing], but it's vital that we look at the root causes,” he says. Like: Why young people want to start using this addictive, harmful and increasingly expensive drug in the first place? 

Rahal says that 4Front Project know of young people who have been hospitalised because of lean. Some have experienced lean comas for up to two days. “[It’s about] living in a society with a lack of support, a lack of guidance and a lack of love,” he explains. “How they deal with that is to escape from reality.” 

This lack of support can be seen in the drastic government cuts in youth drug and alcohol addiction services over the past decade. In March this year, it was reported that funding had declined by £26m between 2014 and 2020, with the number of young people accessing treatment in England down by 40 percent – numbers that are only set to worsen due to continuing pandemic induced disruption. 


There’s also a feeling that even well-meaning charities and specialist drug and alcohol services haven’t quite caught up with the new popularity of lean. “We've worked locally with organisations that specialise in young people and drugs,” Rahal continues, “but they didn't know how to respond [to lean] because they were three years behind.”

It’s unlikely that lean use will remain so underexplored for long. In the meantime, it’s about harm reduction. Rahal says that some of the young people don’t see their use as an addiction, but do acknowledge their withdrawal symptoms. 

For now, it’s about trying to educate users and create a space for them to reflect on how it affects their lives. “We've worked with our members to help them understand the impact of opioids on their body and mind, the side effects, the withdrawal symptoms,” he says. “We found that many of them did not even know that they were identifying withdrawal symptoms.” 

Though they’ve had success in supporting their members to cut down and stop using lean, it doesn’t stop there. “What [we need] is to invest in a public health approach to support young people to lead fulfilled, prosperous and autonomous lives.”

Drug use is a part of many young people's lives, right across the UK. Whether typical youthful experimentation or something altogether worrying, there’s little use denying the facts: Lean is likely here to stay. Understanding how and why is the best chance of mitigating the consequences.  

@Ffranciscodgf / @Eonapa