Lean is a dangerous substance due to its active ingredient, codeine. The effects of consuming large quantities of codeine are similar to heroin or morphine use. It also has a high potential for addiction and abuse. The high concentrations of codeine in lean can lead to brain and other system damages. Lean also contains Promethazine, which is a central nervous system depressant that can lead to slow breathing and even complete respiratory arrest when cojoined with codeine. Lean has significant amounts of DXM (Dextromethorphan), which is a cough suppressant that has the capacity to form an addiction.

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