Codeine: The Over-the-Counter Danger

Article Contributed By: Crystal Karges, MS, RDN, IBCLC for Addiction Hope

eye-263429_640Many stereotypical ideas about drug abuse often include illicit street drugs, such as marijuana or cocaine. However, any drug, if misused, can easily and quickly lead to an addiction.

Assumptions are often made about over-the-counter and prescription drugs, including the thought that these drugs are somehow “safer” than street drugs. Individuals may legitimately use prescription and over-the-counter drugs for intended medical purposes, but over time, this can eventually lead to an addiction.

The reality is that prescription and over-the-counter (OTC) drugs are the most commonly abused substances by Americans ages 14 and older, after marijuana and alcohol [1].

Codeine in Cough Syrup

One of the most regularly abused OTC/prescription medications includes cough-and-cold drugs, particularly codeine based cough syrup. Promethazine-codeine cough syrup is a medication only available by prescription that contains codeine, an opioid that functions as a cough suppressant and induces feelings of euphoria and relaxation.

An emerging trend in drug use recently reported is the concoction known as “Purple Drank”, which includes prescription-strength cough syrup as a recreational drug. The mixture includes high doses of the cough syrup with soft drinks or alcoholic beverages and is known by several street names, including:

  • “Sizzurp”
  • “Purple Jelly”
  • “Texas tea”
  • “Tsikuni”

Though the use of cough syrup may appear seemingly safe, high dosages can depress the central nervous system and cause the user to stop breathing. As codeine is an opioid based drug, it does present with a high risk of fatal overdose if used improperly.

A Dangerous Blend of Drugs

profile-384540_640Claiming the lives of numerous victims, “Purple Drank” is a highly addictive and dangerous blend that is quickly gaining popularity as it being glamorized through the entertainment industry. This can be problematic for younger children and adolescents, who are frequently, exposed to various media outlets in this present day.

According to a recent report from the United States Drug Enforcement Administration, one in ten teenagers admits to using cough syrup or cold medicine to get high [2]. Steve Paslerb, the President and CEO of The Partnership at, has noted,

“Kids are seeing this all over – on social media, on the Internet. They’re seeing their favorite music stars talking about this, singing about this and then they turn to the medicine cabinet. These are dangerous prescription drugs. Whether they are mixed with soft drinks or mixed with Jolly Ranchers, it doesn’t change that fact. This is one of the more dangerous ways, frankly, to get high.” [2]

Discussing the Dangers with a Teen

As a parent or guardian, it can be particularly troublesome to learn of these drug fads that are rampantly circulating among social circles. However disturbing, it is important to be aware of these practices and proactively discuss the dangers of “Purple Drank” with your children and teenagers, as this may be something they encounter.

The integration of codeine, or a cough syrup, with soda, may be tricky to recognize at a party or appear to be relatively harmless. Practicing consciousness and alertness to this growing drug trend can be life-saving.

What are signs/symptoms that may be present in the case of Purple Drank abuse? A person who has become intoxicated with the purple drank concoction may present the following signs and symptoms:

  • Impaired motor skills
  • Drowsiness
  • Slurred Speech
  • Loss of coordination and balance
  • Droopy eyes or uncontrolled eye movement
  • Nausea and vomiting
  • Weakness and/or fainting
  • Seizures, tremors
  • Hallucinations, psychosis

Mixing the codeine in prescription cough syrups with other drugs, such as Ecstasy, or with alcohol can produce fatal effects, even with small dosages. Though the addictive nature of the combination of codeine-based cough syrup with other beverages is often underestimated, the truth is that this dangerous cocktail could prove to be lethal.

Keep Track of Drugs to Prevent Abuse

Take the time to discuss the dangers of Purple Drank with your child or teenager as a preventative measure. Also be sure to consistently regulate the drugs and medications that may be in your own home.

Potentially addictive drugs, such as codeine-based cough syrup, may be unnecessary to keep on hand and should be properly disposed of when the prescription is no longer needed. Taking precautionary actions, such as talking openly and appropriately regulating medications in the home, can be helpful measures for preventing potential abuse of codeine through the concoction of Purple Drank.


  1. National Institute on Drug Abuse, “Drug Facts: Prescription and Over-the-Counter Medications”,
  2. Today News, “What’s ‘sizzurp’? A Dangerous Way for Kids to Get High”,