The title of the album is a reference to the old Rizla cigarette papers packet, which used to contain a printed note near the end saying "Only five leaves left". The album title could also be a reference to an O. Henry short story entitled "The Last Leaf". Drake died five years after recording the album.
Q cited it as "The pinnacle of a melancholy canon of work so distinctive that admirers can only speculate miserably on what might have been."Alternative Press called it "[one] of the most beautiful and melancholy albums ever recorded."
Five Leaves Left was ranked 85th in a 2005 survey held by British television's Channel 4 to determine the 100 greatest albums of all time. In 2003, the album was ranked number 280 on Rolling Stone magazine's list of The 500 Greatest Albums of All Time. NME ranked it at number 74 in their list.Q magazine included the album in its list "Best Folk Albums of All Time".