Sippin’ Syrup: Killing Us Softly

“It taste great doc! I don’t even drink on that Henn anymore. You should try it; taste better than any margarita I’ve ever had.  Just give me a cream soda or some fruit punch, mix it with that purple, and it’s on!”    This was only part of a conversation I had with a patient […]

“It taste great doc! I don’t even drink on that Henn anymore. You should try it; taste better than any

margarita I’ve ever had.  Just give me a

cream soda or some fruit punch, mix it with that purple, and it’s on!” 


This was only part of a conversation I had with a patient

who tried in every way possible to get me to write him a prescription for a

pint of “lean,” “purple” or what we call in the medical community, Promethazine

with codeine (PC). 


The street value for a pint of undiluted PC is $500, but

more often this pint is “cut” with Karo syrup by the local street pharmacists

to “stretch it out.”  A gallon of PC

“stretched out” can generate well over $3600 dollars on the streets.


In addition to being lucrative for the street pharmacists,

the presence of “dat syrup,” “sizzurp” or “lean” was made popular by DJ Screw

and the Houston Hip-Hop culture, and it became a common social drink among young African-Americans all across the nation. 


References to PC are common in songs like Three 6 Mafia’s

“Sippin’ on Some Sizzurp” and Lil Wayne’s freestyle rap “Live From 504.” As

popularity increases for PC, the question arises, Why are people obsessed with PC?

Answer: It’s the codeine!


Codeine, a commonly prescribed and effective drug used to

treat pain, diarrhea and to suppress cough, is the most widely used and

naturally occurring opiod or narcotic (medicines that produce pleasure and

calmness) in the world.  It comes from

the opium poppy, and is related to morphine and heroin. 


Codeine is also the base material for the production of two

other narcotics, hydrocodone and dihydrocodeine.  Compared to morphine, codeine produces less

pain relief, and is usually taken by mouth in liquid or tablet form. It is

often combined with aspirin or acetaminophen (Tylenol) to enhance its affects

on the body. Promethazine, which does not contain codeine, is the generic name

for a sedating, anti-nausea chemical this is often combined with codeine in

cough syrups. 


The combination of promethazine with codeine to control

cough and cold symptoms is very effective when used properly, but can become

addictive and dangerous when misused because of the codeine.  Most Americans take their medications

responsibly, however in 2003, approximately 15 million people in the United

States reported using a prescription drug for non-medical reasons at least once

during the year. 


Prescription drug abuse has become a problem for several

reasons. Use of prescription drugs is viewed as safe because a doctor

prescribed it; it is readily accessible in home medicine cabinets; and

medicines that normally need a prescription can now be purchased online without

seeing a doctor, thus lessening the chance that one could get caught by the

authorities for purchasing and using an illegal substance. 


The three types of drugs commonly misused or abused in this

country include:


opioids – which are

prescribed for pain reliefcentral nervous system

depressants – often referred to as sedatives or tranquilizers

(i.e. barbiturates and benzodiazepines) which are prescribed for anxiety

or sleep problemsstimulants – which

are prescribed for attention-deficit hyperactivity disorder (ADHD), the

sleep disorder narcolepsy, or obesity


Symptoms of overdose on opiods like

codeine include constipation, slow breathing, seizures, dizziness,

weakness, confusion, tiredness, cold and clammy skin, small or constricted

pupils, loss of consciousness, coma and possibly death! 


To experience the

effects of codeine, the human body must convert the drug to morphine. The

effects of codeine start 10 to 30 minutes after ingestion, peak within one to

two hours, and may last four to six hours, depending on how much is taken. Within

two to three weeks of repetitive use, a physical and psychological addiction

may develop. Misuse will lead to an apathetic, dulling-type effect, a lack of

co-ordination and dulled responses.


The effects of the

misuse of prescription drugs are not limited to just those that are of middle

or lower income, there are popular artists that have also suffered the

repercussions of misusing these drugs. 


The cause of death

for Robert Earl Davis, Jr., also known as DJ Screw, at age 30 was attributed to

the result of combining PC with marijuana and alcohol. 


Unfounded rumors have

circulated about Pimp C’s death being related to an overdose of PC, however the

autopsy results show that the PC only contributed to his death. Pimp C had a

condition called sleep apnea (which we will talk about in my next article) that

did not mix well with the cough syrup. Together, they caused his death. 


The bottom line is

that, recreational use of PC is dangerous, addictive, potentially life

threatening, and illegal to use without a prescription. Be careful what you

sip…it could be your last. 

   Dr. Rani Whitfield is a board certified Family

Practice and Sports Medicine Physician living in Baton Rouge, LA.  He is affectionately known as “Tha Hip Hop

Doc”as he uses music and medicine to educate young people on health issues. For

more information, go to or You can email Tha Hip

Hop Doc at