Overview
What is Codeine Cough Syrup?
Codeine is an opioid analgesic found in many prescription cough medicines, including various brands sold in Kenyan pharmacies. When large volumes of codeine syrup are consumed, the codeine produces opioid effects including sedation, euphoria, and pain relief.
"Lean" (also called purple drank or sizzurp) is a drink made by mixing codeine cough syrup with a carbonated soft drink and sometimes candy. It originated in the United States hip-hop scene and has been promoted through social media and music, which has significantly increased its popularity among Kenyan youth.
In Nigeria, codeine syrup abuse reached such severity that the government banned its manufacture and sale in 2018. In Kenya, the problem is growing, particularly among young people in urban areas.
What it does to the brain and body
How does it work?
Why people use it
What draws people to it?
"Lean" has been heavily promoted through social media platforms and is associated with a glamorous, affluent image through its association with Western music and celebrity culture. This has made it aspirational for many young Kenyans.
Codeine syrups are widely available from pharmacies without adequate prescription controls, making them easy to obtain without the social stigma or legal risk associated with street drugs.
The opioid effect provides relaxation and a mild euphoria that is appealing to people managing stress, anxiety, or social pressure.
Short-term effects
What happens when someone uses it?
These effects can occur even with first-time or occasional use.
- Sedation, relaxation, and mild euphoria
- Slowed breathing and heart rate
- Nausea and constipation
- Impaired coordination and reaction time
- Itching (common opioid side effect)
Long-term effects
What happens with regular or prolonged use?
- Physical opioid dependence
- Liver damage from large volumes of the syrup (which contains other active ingredients alongside codeine)
- Dental decay from high sugar content
- Transition to harder opioids as tolerance develops and codeine no longer provides sufficient effect
- Respiratory problems from the promethazine often present in lean formulations
Recognising a problem
Signs that use may have become a problem
These signs apply to the person using the substance and can also help family members or friends recognise when help is needed.
- Regularly purchasing large quantities of cough syrup outside of illness
- Mixing cough syrup with drinks and consuming it socially
- Feeling unable to relax or socialise without it
- Escalating the amount needed to get the same effect
- Feeling unwell (restless, aching, irritable) when unable to access it
Addiction and dependence
How addictive is it?
Codeine is a full opioid agonist. While its effect is milder than heroin or morphine, regular heavy use produces physical dependence through the same mechanism. Many people who develop opioid use disorder in Kenya started with codeine syrup.
The trajectory from codeine to harder opioids is well-documented. Nigeria's codeine crisis directly preceded a surge in heroin use. Kenya may be on the same trajectory.
Overdose and acute danger
When does it become immediately dangerous?
- Breathing that becomes very slow or stops
- Blue lips or fingernails
- Loss of consciousness
- Combination with alcohol or diazepam greatly increases this risk
- Opioid overdose from codeine requires the same emergency response as any opioid overdose. Call 999 immediately.
Withdrawal
What happens when someone tries to stop?
Who is most affected
Groups particularly at risk in Kenya
Young people aged 15 to 25, particularly those active on social media, have been the primary group drawn to "lean." The social media promotion of lean as a lifestyle choice is a specific and documented driver of use in Kenya.
Schools and universities in Nairobi are documented sites of lean use. Students share the drink socially in the same way they might share alcohol.
In Kenya
What the data says about Kenya
Codeine syrup misuse is documented across 12 of 18 surveyed Kenyan counties. Social media promotion of lean, including on TikTok, Instagram, and YouTube channels, is a specific concern flagged by NACADA.
The Pharmacy and Poisons Board has issued guidance to pharmacies about codeine dispensing practices, but enforcement is inconsistent and many pharmacies continue to sell codeine products without verifying prescriptions.
Nigeria's experience serves as a warning: the country's codeine abuse crisis became so severe that manufacturers were banned from producing it. Kenya should not wait to reach that point before strengthening controls.
Across East and Central Africa
How is it used in the wider region?
| Country | Local name(s) | Context and notes |
|---|---|---|
| Nigeria | Lean, Codeine, Mkpoko | Nigeria experienced one of the most severe codeine abuse crises globally. BBC Africa documentary in 2018 revealed millions of bottles consumed daily in some northern states. Government banned manufacture. |
| South Africa | Lean, Tussin | South Africa rescheduled codeine to prescription only in 2018 specifically because of misuse. Significant social media-driven use among youth documented. |
| Uganda | Cough syrup, Lean | Growing misuse documented in Kampala among youth. Social media promotion identified as a driver. |
| Tanzania | Lean, Syrup | Emerging problem in Dar es Salaam among university students. |
Getting help
Where to turn in Kenya
NACADA Helpline
Free, confidential counselling and referral to treatment centres near you. Available 24 hours a day.
Mathari National Hospital
Kenya's main national psychiatric and substance use treatment facility in Nairobi. Inpatient and outpatient services.
County referral hospitals
Every county in Kenya has a mental health and substance use service. Ask at your nearest hospital or health centre.
NACADA Helpline
For counselling and referral for codeine or opioid dependence.
Sources
References
- Nation Africa. (2021, June 26). Ya-Ba, happy water, meow: list of drugs abused by the youth keeps growing.
- National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA). (2021). Assessment of Emerging Trends of Drugs and Substance Abuse in Kenya 2021. Nairobi: NACADA.
- BBC Africa. (2018). Nigeria's codeine crisis documentary.
- Van Hout, M. C., et al. (2017). Codeine Is My Helper: Misuse of and Dependence on Codeine-Containing Medicines in South Africa. Qualitative Health Research.