Intro:

Codeine, a widely prescribed schedule III drug, is known for its ability to manage chronic pain
related to various conditions. Derived from the Opium Poppy plant, codeine has analgesic
properties, which also contribute to its rising rates of misuse throughout our nation. Despite its
pervasiveness in our population, codeine is about 7-14 times less potent than morphine1. Codeine
has many associated off-label benefits, which are unapproved benefits of an approved drug.
These off-label uses include “ cough, persistent diarrhea, and restless leg syndrome”2. Codeine is
commonly used in combination with other drugs to produce an effect3.

Codeine is widely found being used in street drugs in a drink commonly known as “lean”. The
drink consists of prescription cough syrup, which has promethazine and codeine, as well as some
sort of soda and hard candy. Purple Drank, another name for this drink, produces effects that
align with the typical abuse profile of other opioids, inducing a sedative state and a euphoric
sensation characterized by dizziness or a delirious feeling. This concoction, considered a narcotic
beverage, carries a high risk of addiction and has been implicated in numerous cases of fatal
overdoses.

The mechanism of action of this codeine is similar to other opioids. Codeine will bind to an
opioid receptor, in this case, μ-receptors, and trigger a cascade of cellular reactions2. First, there
will be a decreased quantity of cAMP, and then the neurons will be hyperpolarized, reducing the
likelihood of them firing an action potential2. The μ-receptors located in the midbrain serve as
the predominant target for codeine, facilitating its analgesic effects2.

References:
1.Kay DC, Gorodetzky CW, Martin WR. Comparative Effects of Codeine and Morphine in Man.
Journal of Pharmacology and Experimental Therapeutics. 1967;156(1):101-106.
https://jpet.aspetjournals.org/content/156/1/101#:~:text=Using%20these%20parameters%2C%20
valid%20potency. Accessed July 17, 2023.

2‌ .Peechakara BV, Gupta M. Codeine. PubMed. Published 2022.

https://www.ncbi.nlm.nih.gov/books/NBK526029/#article-19677.s3. Accessed July 17, 2023.

3.Codeine: MedlinePlus Drug Information. medlineplus.gov.

https://medlineplus.gov/druginfo/meds/a682065.html#:~:text=Codeine%20is%20used%20to%20
relieve. Accessed July 17, 2023

4.D E P A R T M E N T O F J U S T I C E U. Resurgence in Abuse of “Purple Drank.”; 2011.

https://www.justice.gov/archive/ndic/pubs43/43924/sw0008p.pdf. Accessed July 17, 2023