Hip-Hop’s Unlikeliest Icons: Promethazine Codeine Syrup Manufacturers

The companies that fuel purple drank’s kick.

Photograph: Grant Cornett for Bloomberg Businessweek

Inside the recording studio at Screwed Up Records & Tapes, William Gibbs lights up a Black & Mild and pauses to consider how long he’s been sipping. Next to Gibbs—who’s better known as Will-Lean, a member of the legendary Houston hip-hop collective Screwed Up Click—is a tall, white Styrofoam cup. The concoction inside mixes Faygo Redpop, a strawberry-flavored cream soda, and promethazine codeine cough syrup, a prescription pain reliever and cough suppressant that’s also the main ingredient for any number of similar cocktails referred to as “drank,” “purple stuff,” “lean,” and “sizzurp,” among other names.

Gibbs decides he’s been sipping since the mid-’90s. “I feel like I’m checking myself into rehab or something,” he says as he ponders his history. “I don’t get high. I just drink it for the taste. It tastes as good as a motherf-----. Shit don’t do anything for me anymore, but I still do it.” He’s made good headway on his Redpop, and his relaxed vibe reflects it—the effects include numbness, lethargy, and euphoria.

In the parking lot out front, on West Fuqua Street in the South Park neighborhood of Houston, someone is tossing chicken legs, boudin sausage, and rib slabs on a grill. This isn’t just any Wednesday afternoon on the South Side: It’s the 16th anniversary of the death of Robert Earl Davis Jr., better known as DJ Screw, the main popularizer of “chopped and screwed,” the technique that helped put the Houston hip-hop scene on the map. Davis would slow down the tempo of a song to make it seem as if the music were unfolding in slow motion, layering in new beats and scratches. He died in November 2000 of a “codeine overdose with mixed drug intoxication,” according to the autopsy report, just as the styles he helped pioneer were becoming synonymous with the slower pace of Southern cities. To many, the music spoke of everyday life, which for some people included drinking drank. Artists such as Lil Wayne and Justin Bieber have since celebrated its high, spreading its fame and boosting recreational consumption.

The rising visibility of promethazine codeine syrup also made the pharmaceutical companies that manufacture and sell it part of some communities’ everyday vernacular. Users and dealers might not know how these companies did last quarter, but they all have opinions on who puts out the sweetest, most potent sip. “Right now, these motherf-----s drinking anything. They got green shit, yellow shit, red shit,” Gibbs says. “But most people are drinking the Hi-Tech red, Wockhardt green, and Qualitest. Those are the choices you have right now.”

Bottles of promethazine codeine cough syrup produced by Hi-Tech Pharmaceuticals Inc. and Wockhardt Ltd. subsidiary Morton Grove Pharmaceuticals Inc. sell on the streets of Houston for $750 to $1,000 a pint, say the users, dealers, and experts who were interviewed for this story. If you have some extra scratch, there’s syrup from Actavis (now Allergan Plc), the king of the market until the company stopped selling the product in 2014. As recently as nine months ago, the remaining pints of Actavis syrup could fetch anywhere from $2,500 to $3,000, says Ronald Peters, a retired professor of behavioral sciences at the University of Texas Health Science Center in Houston. “It’s the caviar of drugs,” says Peters, who’s been researching the cultural influence of cough syrup since the mid-1990s.

“If you have Actavis or Hi-Tech, those are like the Michael Jordan of sipping drank,” says a user who will identify himself only as Scooby. The taste is distinctive, he adds: “The syrup could have been named the Magic Potion Bottle, and I would have known which pharmaceutical companies were making money.” Scooby, who says he’s 33 and unemployed, started sipping when he was 15 and still does on occasion. “It was embedded into our head to sip drank,” he says. He recalls that friends and neighbors would sit around a local swimming pool, holding Styrofoam cups.

Inside Screwed Up Records & Tapes. 
Photographer: Todd Spoth for Bloomberg Businessweek

 

In 2016 promethazine codeine syrup was prescribed about 4 million times in the U.S., according to data compiled by Bloomberg Intelligence, and brought in $15 million in sales—a slight decline from when Actavis was on the market. These figures are curiously small relative to the syrup’s cultural influence, but enough reaches the illegal market to keep it in the public eye. Last year, according to the Atlanta Journal-Constitution, investigators in Georgia found that technicians at Emory University Hospital Midtown in Atlanta had diverted 110 gallons of promethazine codeine to the street from 2008 to 2013, leading to a $200,000 fine. (The hospital told the newspaper it had systems in place to prevent such thefts, which it had strengthened in the wake of the revelations.)

It’s difficult to know how big the illegal market is or how many of the estimated 2.1 million Americans addicted to prescription opioids are abusing promethazine codeine. The quality of addiction and overdose statistics varies from state to state, and measuring codeine abuse has been a lower priority than monitoring opioids such as oxycodone, hydrocodone, methadone, and fentanyl, whose use has exploded in recent years. But in 2011, the most recent year for which data are available, codeine (in all forms) was the reported cause of 11,000 U.S. emergency room visits, according to the Department of Health and Human Services. A 2013 study of more than 2,300 college students in the Southeast found that at least 6.5 percent had taken drank. That same year the U.S. government’s National Institute on Drug Abuse said promethazine codeine cough syrup had become “increasingly popular among youth in several areas of the country.”

In the two decades since promethazine codeine was first reported as a substance abuse trend, pharmaceutical companies have rarely acknowledged, let alone taken steps to combat, the illegal market. By contrast the companies most closely associated with the broader opioid epidemic have occasionally been called to account for their practices and have defended themselves publicly. For example, the maker of OxyContin, Purdue Pharma LP, in 2007 pleaded guilty to charges of misleading regulators, doctors, and the public about the addiction risks of its product; Purdue has since said that it reformulated the drug to give it “abuse-deterrent properties” and that it’s funding programs to help prevent pharmacy robberies.

Despite drank’s currency in pop culture, the syrup companies have largely managed to avoid such controversy, leaving experts and users to speculate on whether they regard the illicit market as a problem or an opportunity. “There ain’t no difference between what happens with these pharmaceutical companies and what happens with McDonald’s,” Gibbs says.

Promethazine codeine cough syrup began its rise in 1952, when a company called Ani Pharmaceuticals applied to the Food and Drug Administration for approval of what was originally known as “Phenergan expectorant with codeine.” The formulation paired promethazine, an antihistamine developed in France in the 1940s, with a painkiller that had been in use for more than a century. After a winding regulatory path, promethazine codeine was declared safe and effective by the FDA in 1984.

Dr. David Corry, chief of the Immunology, Allergy, and Rheumatology section at Baylor College of Medicine in Houston, says the idea is to block with one drug the major symptoms of allergies. “The codeine covers the cough; the promethazine covers everything else.” The problem with the combination, he adds, is the severe side effects, which include “altered mental status.”

Drank has been around almost as long as promethazine codeine. In the 1960s, according to author Lance Scott Walker, who’s written two books on Houston’s hip-hop culture, the city’s blues musicians began experimenting with a mixture of cough syrup and beer. After the FDA declared promethazine with codeine effective, users had a buffet of choices. Actavis was the first company to get a formulation on the market, labeling it Prometh With Codeine Cough Syrup. Wockhardt followed not long after with Promethazine Hydrochloride and Codeine Phosphate. By 2013 at least seven pharmaceutical companies—Actavis and Wockhardt, plus Pharmaceutical Associates (now defunct), Hi-Tech (now owned by Akorn Pharmaceuticals), Nostrum Laboratories, Tris Pharma, and Amneal Pharmaceuticals—had received approval for at least 27 different promethazine codeine products, according to FDA records.

The first company to market was also the first to recognize publicly that some people were using its product recreationally. Over the years, Actavis’s Prometh With Codeine formulation and its distinctive orange-and-white label had remained largely unchanged, and the liquid became the “purple standard” on the streets. Or the pink standard, rather: It was known, as the hip-hop artist 2 Chainz pointed out in a 2016 interview with WorldstarHipHop, for turning pink when mixed.

As Actavis was gaining in popularity, artists of varying degrees of celebrity were name-checking it or being otherwise associated with it—most crucially, 2 Chainz said, Bieber, the megafamous Canadian pop star. In early 2014, TMZ had published multiple anonymously sourced reports on Bieber’s alleged drank abuse, including one saying that he was a “fan of Actavis prometh with codeine cough syrup.” (Bieber has never responded to the allegations, although TMZ later reported that people close to him said he’d stopped sipping. A representative for Bieber didn’t reply to a request for comment.)

That spring, Actavis pulled the product altogether. “Actavis has made the bold and unprecedented decision to cease all production and sales of its Promethazine Codeine product,” a company official told TMZ, adding that the attention “has glamorized the unlawful and dangerous use of the product, which is contrary to its approved indication.” Asked to comment further, an executive with Allergan directed Bloomberg Businessweek to Teva Pharmaceutical Industries Ltd., which purchased Allergan’s generics business last August. A Teva representative said the company was “unable to comment on the historic products as it relates to decisions of the legacy Actavis.”

In August 2015, Wockhardt became the second company to publicly address the issue of recreational use of promethazine codeine syrup, following a controversy related to a syrup put out by its subsidiary Morton Grove. Three days after the Chicago Tribune published an article highlighting how the local suburb of Morton Grove, where the subsidiary is based, had become synonymous on social media with purple drank, Wockhardt issued a statement about what it called the “disturbing practice” of unapproved use of its syrup. “While some may attempt to glamorize it, prescription drug abuse is a public health problem,” the company said. “We will continue to work with law enforcement and others to deter the unauthorized use of prescription cough medicine.”

The acknowledgment that the syrup was being used recreationally was something, but to date, Wockhardt, which didn’t respond to multiple requests for comment, doesn’t appear to have taken any public steps to prevent abuse. And with Actavis out of the picture, the users and experts interviewed for this article say, Morton Grove and Hi-Tech gained market share.

Peters says that, based on his research with users, dealers, and pharmacists, Hi-Tech’s Promethazine HCI and Codeine Phosphate Syrup CV was likely the highest-selling promethazine codeine product on the streets of Houston in 2015. That same year, Hi-Tech’s parent company, Akorn, an Illinois-based generics manufacturer, introduced a second promethazine codeine formulation with the unwieldy name of Promethazine Hydrochloride, Phenylephrine Hydrochloride and Codeine Phosphate Syrup CV.

As yet, Akorn hasn’t publicly acknowledged off-book use of its promethazine codeine cough syrups. But Peters says he believes the company tacitly recognized their street value last year, by changing its packaging from plastic bottles to glass ones, which he says results in a more bitter-tasting syrup. (Akorn didn’t respond to requests to address the assertion.) He adds that the street value for Hi-Tech has dipped slightly since the change in bottles, but that “it’s still really wanted and one of the biggest sellers on the street market.”

Peters developed his expertise during the 1990s, when he researched drank and hip-hop culture while getting his doctorate in health promotion research and development. He went from high school to high school, witnessing kids share Sprite bottles full of drank and sometimes pass out in class. That led him to investigate the companies that produced and sold the syrup. He noticed a pattern of financial success that moved from one company to the next, as brands changed hands and public attention to drank increased. Actavis, he says, “passed the baton to the next company.”

Gibbs in front of a mural memorializing DJ Screw.
Photographer: Todd Spoth for Bloomberg Businessweek

He says he believes that, with the packaging shift, Akorn might have been showing genuine concern about the recreational market. “To me, these were some ethical people who knew they were making a lot of money on the syrup,” Peters says. David Ferguson, a professor of medicinal chemistry at the University of Minnesota who studies the pharmacology of widely abused drugs, takes a more skeptical view. “If people believe these companies are fighting the good fight to remove or end diversion or the illegal trafficking and sales on these products, I think they would be naive,” he says. “These are big markets.”

Calls and emails to other promethazine codeine syrup manufacturers, in addition to Akorn and Wockhardt, weren’t returned. An exception was Endo, the parent company for Par Pharmaceutical, which sells Qualitest’s promethazine codeine product, another popular syrup. “[P]atient safety is a top priority for Endo and we are committed to providing patients with approved products that are safe and effective,” wrote Heather Zoumas Lubeski, a senior director for corporate affairs. “While it is not among our company’s leading products, promethazine with codeine remains a viable treatment option for physicians and patients when used as prescribed.”

Dr. Corry, of Baylor College of Medicine, questions whether promethazine codeine should still be an option. “There are more effective options around today that have greatly reduced side effects,” he says. “Usually, the ultimate use for promethazine codeine will be recreational. There really is no medical use for this kind of combination.” He adds: “I would be in favor of the FDA looking at banning it.”

The FDA has been scrutinizing codeine anew since 2013—requiring, for example, that warnings be added to labels highlighting the risks to children—but it has yet to publicly tackle the dangers connected to recreational use of promethazine codeine syrups. “The FDA’s actions in this area are based on the latest safety data available,” Sarah Peddicord, a press officer for the agency, wrote in an email. “The agency is currently evaluating all available information to determine whether additional communication and/or regulatory action is needed.”

On the enforcement side of the equation, promethazine codeine has been overshadowed by other prescription opioids. Doug Coleman, special agent in charge of the Drug Enforcement Agency in Arizona, worked cases related to promethazine codeine in predominantly black neighborhoods throughout the U.S. for a year around 2003, tracking the manufacturing and prescriptions that would go out for the syrup. He says the DEA focuses on larger-scale investigations involving organizations or “dirty doctors.” “If it gets down to the street level, where let’s say somebody takes a couple bottles of this product and they’re distributing around the lower levels, then we really don’t get around to it so much,” he says.

In the summer of 1992, DJ Lil Randy was riding around Houston in the back of a friend’s car when he was handed a bottle of Boone’s Farm wine. Inside was promethazine codeine cough syrup. He loved the taste, which he compares to fruit punch. “We weren’t really mindful about the drug part of it at first,” he says. “It was strictly the taste that got us. After that, it kinda became an everyday thing.” He pauses, lowering his head for a moment before continuing. “If I had known then what I know now, I don’t think there’s any way I would be talking about it on a mixtape,” he tells me. Drinking syrup, he says, “went from a fad to a population to a community.”

There was a time when it seemed as if you couldn’t listen to a track from a Houston hip-hop artist, DJ Lil Randy included, on a mixtape or on 97.9 The Box, the city’s premier hip-hop radio station, without hearing at least one reference to syrup. As Screwed Up Click’s popularity was on the rise in the late ’90s, Randy’s dependence grew into addiction. He was in jail for possession of codeine in 2000 when his best friend and co-pioneer, DJ Screw, died. When Randy was released after a three-year stint, he says, he sobered up and began learning about the effects of abuse on the brain and kidneys. “As long as promethazine codeine stays in the hip-hop, impoverished, and less fortunate communities, it’s not going to be addressed by these companies,” he says.

Scooby, the unemployed user, says that after spending a fortune over the years, he’s weaned himself to the point that he rarely sips. He expresses skepticism about the companies but says he hopes they might publicly recognize the drug’s effects: “People need to sway them that what goes on here is legit. I don’t think they want to hear people like me.”

Outside Screwed Up Records, a few people get out of a car to snap photos of the mural of DJ Screw. Inside, Gibbs takes a sip from his white cup. Sitting back in his chair, he offers no indication that he’ll slow down on drank, despite his protestations that he’s essentially immune to the buzz. Far from hoping the companies will stem the flow of syrup into poor communities, he says they should acknowledge the role that he and others in hip-hop have played for their products. “I feel like they should break off a check or at least drop off a couple of cases,” he says, laughing through the smoke from his Black & Mild. “We’ll keep it confidential.”