No. While both refer to a kind of medicine abuse, they are not the same thing. Both involve taking dangerously high doses of cough suppressants, but the active ingredient differs. DXM is the active ingredient in over-the-counter medicines. The active ingredient in lean is codeine, which is only available with a prescription. Lean is sometimes referred to as “drank,” “purple drank,” “sizzurp,” or “syrup.” Lean can depress the central nervous and respiratory systems, causing the lungs and heart to stop functioning. Known side effects of codeine abuse can include addiction, nausea, sedation, stomach bleeding, kidney and liver damage, convulsions, hallucinations, depression, tremors and seizures.