LOS ANGELES -- The powerful narcotic popped up on the cultural grid around the turn of the millennium. A Houston producer-remixer named DJ Screw paid homage to its woozy, heavy-lidded high by dramatically slowing down beats and vocals to replicate the drug's sleepwalker euphoria.
Among Southern rappers, the chemical mixture -- called "sizzurp" on the street -- soon became as ubiquitous as gold jewelry.
This wasn't some exotic new hallucinogen. In fact, it was usually mixed with fruit soda and sipped from oversize plastic foam cups. A cough syrup fortified with codeine and promethazine and bought with a prescription, it was highly addictive -- and technically legal.
Over the past dozen or so years, sizzurp has become a quietly pervasive cultural force that has infiltrated the Top 40 by way of the hip-hop genre "chopped and screwed," pioneered by DJ Screw. The sound has turned up on tracks by elite hit makers including Beyoncé, Kanye West and, most notably, dreadlocked rap superstar Lil Wayne.
When news broke that Lil Wayne was hospitalized after suffering a seizure on a music video set March 12, many thought sizzurp might be to blame. Spokespeople for the rapper denied it, and he was released from Cedars-Sinai Medical Center six days after he was admitted. Stress, not substance abuse, caused his hospitalization, said Bryan "Birdman" Williams, co-chief executive of the chart-topping rapper's label, Cash Money Records, at the time. Later, Lil Wayne announced that he has epilepsy.
But sizzurp has long existed in the shadows of the music industry, and is even suspected in several deaths.
Followers of Lil Wayne (Dwayne Michael Carter Jr.) know well his affection for "sippin' on syrup," as the phenomenon is known.
As far back as 2005, Lil Wayne rapped affectionately about his favored cocktail -- sizzurp with fruit soda to mask its unpleasant medicine taste -- on the song Lock & Load.
Sizzurp has also provided a street-cred-bolstering talking point in lyrics for star rappers Rick Ross and Far East Movement. And it provoked a minor media frenzy in February, when pop star Justin Bieber was photographed at a party in close proximity to what looked like a bottle of codeine-fortified meds (Bieber has denied taking drugs).
That Lil Wayne would find escape in something as down-market as prescription cold medication may seem at odds with the genre's blinged-out excesses.
"Codeine is an opiate," said Jane Maxwell, senior research scientist at the University of Texas at Austin's Addiction Research Institute. "When you're sipping on syrup, you're sipping on a synthetic narcotic analgesic."
Lil Wayne is seen guzzling what appears to be sizzurp -- also known as "lean" or "purple drank" thanks to the cough syrup's synthetic pastel hue -- in the 2009 documentary film The Carter. (He sued to block the movie's release, accusing its filmmakers of fraud by intentional misrepresentation, but the suit was thrown out by a judge.)
Within the gritty environment that spawned Lil Wayne and Southern hip-hop, purple drank provides a cheap, legal, often medical-insurance-subsidized alternative to crack and heroin, according to Leaning on Syrup, a report on opioid cough syrup abuse from the Texas Commission on Alcohol and Drug Abuse.
In a videotaped public service announcement Lil Wayne posted online in 2011, the rapper addresses his complex relationship with cough syrup:
"I don't do this to be cool," Lil Wayne explains, holding up a container of promethazine codeine syrup clearly bearing his given name. "I did this because I was sick."
Much like heroin
In 2000, just as he was coming to prominence for the chopped and screwed sound, DJ Screw died from an overdose on cough syrup and other substances, including marijuana and alcohol, a medical examiner concluded.
DJ Screw's protégé and a member of his Screwed Up Click crew, MC Big Moe, died at 33 in 2007, after a heart attack and a weeklong coma. No direct connection was made to sizzurp, but Big Moe was not shy about discussing his use of codeine cough syrup.
Also in 2007, Pimp C of the Texas rap duo UGK died at age 33 in Los Angeles after overdosing on codeine cough syrup in conjunction with a pre-existing sleep condition, according to the Los Angeles County coroner.
Medical experts say the codeine in sizzurp -- an opiate in the same family of drugs as heroin and morphine -- makes the habit hard to kick.
"There's a misconception that codeine is a weaker formula of the same class of medicine" as heroin, said Dr. George Fallieras, an emergency room physician at Los Angeles' Good Samaritan Hospital. "But the amount of codeine these guys ingest with the syrup is massive.... It's just the same as someone being addicted to heroin, except they're not using needles."
Los Angeles Times staff writer Amina Khan contributed to this report.