Hydrocodone and Weed: Are They Safe to Mix?

weed and Hydrocodone
By Anthony Pellegrino Updated March 8th

Medically reviewed by Dr. Brian Kessler, MD

Hydrocodone and cannabis are two commonly used substances for pain relief.

Hydrocodone is a semi-synthetic opioid prescribed to treat moderate-to-severe pain. Cannabis, on the other hand, is a natural plant-based substance that has been used for medicinal purposes for thousands of years.

As more states legalize medical and recreational cannabis, it’s essential to understand the potential risks and interactions associated with mixing hydrocodone and weed.

If you’re considering using both, it's vital to explore the effects of combining hydrocodone and weed: the risks, potential side effects, and whether it’s safe to mix the two. We’ll then look at the latest science to determine if cannabis or hydrocodone is more effective at alleviating moderate pain.

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What Is Hydrocodone?

Hydrocodone is a semi-synthetic opioid that is commonly used as a pain medication. It is usually combined with other medicines, such as acetaminophen or ibuprofen, to increase its effectiveness.

Hydrocodone is typically used to treat moderate-to-severe pain, such as pain from injuries, surgeries, or chronic conditions like cancer. It is usually taken orally as a tablet, capsule, or syrup.

Semi-synthetic opioids are drugs created by modifying the chemical structure of natural opioids, such as morphine, codeine, or thebaine, derived from the opium poppy. Hydrocodone is made by combining codeine with thebaine, a chemical found in opium.

Hydrocodone works by binding to opioid receptors in the brain and spinal cord. This binding, then, reduces the perception of pain.

It also affects other parts of the brain that regulate emotions and rewards, which can cause sensations of euphoria and relaxation. This influence on our brain reward systems, however, makes use of the drug susceptible to addiction and abuse.1

Physicians widely prescribe hydrocodone in the United States and other countries. As such, it is one of the most commonly abused prescription drugs.

According to the 2016 National Survey on Drug Use and Health (NSDUH), 6.9 million people in the US, aged 12 and older, abused hydrocodone that year compared to 7.2 million in 2015.

Because of its widespread use and potential for abuse, consumers need to understand the risks and potential interactions that may occur when combining hydrocodone with other substances, including cannabis.

Hydrocodone Risks

patient and doctor

Hydrocodone is a semi-synthetic opioid that is often prescribed for moderate-to-severe pain relief. However, like any medication, hydrocodone carries risks, particularly when it is not taken as prescribed.

Hydrocodone risks include:

Potentially Dangerous Side Effects

Hydrocodone can cause various side effects, including drowsiness, dizziness, nausea, constipation, and dry mouth. In some cases, it can also cause severe or life-threatening side effects, such as slowed or shallow breathing.

Some studies suggest that the incidence of side effects may be higher in patients taking hydrocodone compared to other opioids, such as morphine or oxycodone.2

Potential for Abuse

One of the gravest risks of using hydrocodone is the potential for abuse and addiction. Hydrocodone is a highly addictive drug, and even when taken as prescribed, it can lead to physical dependence and addiction.3

The risk of addiction is higher for those with a history of substance abuse and those who take the drug for a long time.


Taking too much hydrocodone can lead to an overdose, which can cause respiratory depression, coma, and even death. According to the National Institute on Drug Abuse (NIDA), opioids like hydrocodone are responsible for a significant number of overdose deaths in the United States each year.

Interactions with Other Drugs & Medications

Hydrocodone can also interact with other drugs, including:

  • Alcohol: Combining hydrocodone with alcohol can increase the risk of respiratory depression, overdose, and death.4 This is because both substances act as central nervous system depressants, which can slow down breathing and heart rate. It is critical to avoid alcohol while taking hydrocodone and to talk to a healthcare provider about any potential risks or concerns.
  • Other opioids: Taking hydrocodone with other opioids, such as fentanyl or oxycodone, can increase the risk of respiratory depression, overdose, and other side effects.5
  • Benzodiazepines: Combining hydrocodone with benzodiazepines, such as Xanax or Valium, can increase the risk of respiratory depression, sedation, and overdose.
  • Cannabis: Combining hydrocodone with cannabis can increase the risk or severity of certain side effects, such as drowsiness, dizziness, and impaired coordination.

Overall, it is crucial to use hydrocodone only as prescribed by a healthcare professional and to avoid combining it with other substances unless directed by a healthcare provider.

If you have any concerns about using hydrocodone, discuss them with your healthcare provider.

Interactions Between Hydrocodone and Weed

woman vaping and reading

The current research on how hydrocodone and cannabis interact is relatively contradictory. 

Some studies suggest that using cannabis alongside opioids like hydrocodone can amplify its effects and even reduce the risk of opioid toxicity.6,7 Other papers suggest that combining opioids and cannabis may be helpful for pain sufferers without increasing the risk of dependency.8 

However, other studies seem to find the opposite result. A 2017 study found that “Cannabis use appears to increase rather than decrease the risk of developing nonmedical prescription opioid use and opioid use disorder.”9 The following year, a 2018 study concerning oxycodone – a similar semi-synthetic cannabinoid – found that “the combination of 2.5 mg oxycodone and active cannabis produced small, yet significant, increases in oxycodone abuse liability.” 

One of the most significant risks of combining hydrocodone and cannabis is an increased risk of unwanted side effects. Both hydrocodone and cannabis can cause drowsiness, dizziness, and impaired coordination. When used in conjunction, these effects can be amplified, increasing the risk of accidents and injuries. Patients should refrain from driving or operating heavy machinery after using these substances simultaneously.10

Amplified effects can also occur with more serious side effects, such as the risk of respiratory depression.11 Both substances can slow down breathing, which could become dangerous when taken in combination. However, other studies suggest that THC and cannabis have no effect on opioid-induced respiratory depression.12

With further research needed to fully understand how cannabis and hydrocodone interact, patients who have respiratory problems or are taking other medications that can slow down breathing should be especially cautious when using combining the two.

Ultimately, patients using hydrocodone for pain relief should talk to their healthcare providers before using cannabis to ensure the combination does not interfere with their medications.

Can I Combine Hydrocodone and Weed?

cannabis and medication interaction

Both hydrocodone and cannabis are commonly used for pain relief or relaxation, and with the low perceived risk of cannabis consumption, it can be tempting for some consumers to combine the two. However, it’s crucial to understand the risks and potential side effects before doing so.

Hydrocodone is an opioid pain medication that can be highly addictive and can cause serious side effects, such as respiratory depression, dizziness, and drowsiness. When taken with cannabis, the effects can be intensified. This could lead to an increased risk of overdose or other dangerous adverse effects.

One of the most significant concerns medical practitioners and patients have is that both substances can depress the respiratory system, and amplification of that effect by taking both medications simultaneously could lead to slowed breathing and even respiratory failure.

Other potential side effects of combining hydrocodone and marijuana include:

  1. Increased Risk of Addiction: Combining hydrocodone and cannabis can increase the risk of developing a substance use disorder.13 
  2. Impaired Cognitive Functioning: Both hydrocodone and cannabis can impair cognitive functioning, such as memory, attention, and concentration.14 Using these substances together can exacerbate these effects, making it difficult to perform tasks that require mental clarity and focus.
  3. Increased Risk of Accidents and Injuries: Cannabis and hydrocodone can each cause drowsiness, dizziness, and impaired coordination. Using them together can amplify those effects, increasing the risk of accidents and injuries, especially while driving or operating heavy machinery.15

Based on the available research and studies, the risks of respiratory depression, addiction, impaired cognitive functioning, accidents, and injuries when combining hydrocodone and cannabis can be significant. Meanwhile, the potential benefits of combining the two substances are not well-established.

Therefore, it is recommended that users consult with their doctor or healthcare provider before combining hydrocodone and THC. Healthcare providers can offer guidance on safe and effective pain management strategies and monitor patients for any adverse effects.

Hydrocodone or Medical Marijuana: Which is Better for Moderate Pain Relief?

Moderate pain can be debilitating and can significantly affect an individual’s quality of life. For many years, opioids like hydrocodone have been the go-to medication for pain relief. However, with the growing popularity and accessibility of medical cannabis, it’s worth considering which is better for pain relief.

Both hydrocodone and medical cannabis have been effective in reducing pain in patients, but they have different mechanisms of action.

Hydrocodone is an opioid that works by binding to opioid receptors in the brain and spinal cord. In doing so, it helps reduce pain signals to the brain. Medical cannabis contains compounds called cannabinoids, which interact with the body’s endocannabinoid system to reduce pain and inflammation.16

Several scientific studies have compared the effectiveness of drugs like hydrocodone and medical cannabis in treating moderate pain.17

One 2017 study found that medical cannabis patients “report that cannabis is just as effective, if not more, than opioid-based medications for pain.”18 Another study from 2021 found similar results, in which most of a self-selected convenience sample reported that cannabis was much more effective than prescription drugs like hydrocodone. Additionally, many patients said that the side effects associated with prescription drug use were much worse than medical cannabis.19

It’s important to note that these studies are limited in scope, and further research is needed to fully understand the effects of medical cannabis on pain relief.

The two drugs also have unique risks and side effects that may affect the choice a patient and their doctor make. Hydrocodone carries a high risk of addiction and abuse and can cause side effects such as dizziness, nausea, constipation, and respiratory depression. In contrast, medical cannabis has a significantly lower risk of addiction and abuse but can cause side effects such as dry mouth, dizziness, and impaired coordination.

Ultimately, the decision of which treatment is best for moderate pain relief is a personal one. It should be made in consultation with your healthcare provider and should weigh the potential benefits and risks of each treatment given your personal medical history and lifestyle.

For those interested in exploring medical cannabis as a treatment option for pain relief, NuggMD connects patients with licensed doctors who can evaluate their medical condition and recommend a medical marijuana card.

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At the end of the day, combining hydrocodone and cannabis can be risky. Doing so can increase the risk of side effects and adverse reactions, and patients should avoid mixing the two without consulting with their healthcare provider first.


1. Gardner EL. Addiction and Brain Reward and Antireward Pathways. Chronic Pain and Addiction. 2011;30:22-60. doi:https://doi.org/10.1159/000324065

2. Marco CA. Comparison of Oxycodone and Hydrocodone for the Treatment of Acute Pain Associated with Fractures: A Double-blind, Randomized, Controlled Trial. Academic Emergency Medicine. 2005;12(4):282-288. doi:https://doi.org/10.1197/j.aem.2004.12.005

3. Wightman R, Perrone J, Portelli I, Nelson L. Likeability and Abuse Liability of Commonly Prescribed Opioids. Journal of Medical Toxicology. 2012;8(4):335-340. doi:https://doi.org/10.1007/s13181-012-0263-x

4. Kreek MJ. Opioid Interactions with Alcohol. Advances in Alcohol & Substance Abuse. 1984;3(4):35-46. doi:https://doi.org/10.1300/j251v03n04_04

5. Gallagher R. Multiple opioids in pain management. Canadian Family Physician. 2007;53(12):2119-2120. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231548/

6. Bindler RJ, Watson CJW, Lyons AJ, et al. Drug-Drug Interaction Between Orally Administered Hydrocodone-Acetaminophen and Inhalation of Cannabis Smoke: A Case Report. Hospital Pharmacy. 2022;57(4):518-525. doi:https://doi.org/10.1177/00185787211061374

7. Oelhaf RC, Azadfard M. Opioid Toxicity. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK431077/

8. Combining opioids and marijuana may be advantageous for pain sufferers: Study suggests using the two drugs together could reduce risk of dependency without causing cognitive problems. ScienceDaily. https://www.sciencedaily.com/releases/2019/04/190409135930.htm

9. Olfson M, Wall M, Liu SM, Blanco C. Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States. doi:https://doi.org/10.1176/appi.ajp.2017.17040413)

10. Cooper ZD, Bedi G, Ramesh D, Balter R, Comer SD, Haney M. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. Neuropsychopharmacology. 2018;43(10):2046-2055. doi:https://doi.org/10.1038/s41386-018-0011-2

11. M B, M N, E S, L A, Tw S, A D. Non-analgesic Effects of Opioids: Opioid-Induced Respiratory Depression. Current pharmaceutical design. Published 2012. https://pubmed.ncbi.nlm.nih.gov/22747535/

12. van Dam CJ, van der Schrier R, van Velzen M, et al. Inhaled Δ9-tetrahydrocannabinol does not enhance oxycodone-induced respiratory depression: randomised controlled trial in healthy volunteers. British Journal of Anaesthesia. Published online January 31, 2023. doi:https://doi.org/10.1016/j.bja.2022.12.018

13. Cooper ZD, Bedi G, Ramesh D, Balter R, Comer SD, Haney M. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. Neuropsychopharmacology. 2018;43(10):2046-2055. doi:https://doi.org/10.1038/s41386-018-0011-2

14. Dublin S, Walker RL, Gray SL, et al. Prescription Opioids and Risk of Dementia or Cognitive Decline: A Prospective Cohort Study. Journal of the American Geriatrics Society. 2015;63(8):1519-1526. doi:https://doi.org/10.1111/jgs.13562

15. Jin L, Vermund SH, Zhang Y. Trends in Prescription Opioid Use in Motor Vehicle Crash Injuries in the United States: 2014–2018. International Journal of Environmental Research and Public Health. 2022;19(21):14445. doi:https://doi.org/10.3390/ijerph192114445

16. Guindon J, Hohmann AG. The Endocannabinoid System and Pain. CNS & neurological disorders drug targets. 2009;8(6):403-421. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834283/

17. Khalid N, Singh A. Cannabis Versus Opioids For Pain. Nih.gov. Published January 25, 2022. https://www.ncbi.nlm.nih.gov/books/NBK573080/

18. Reiman A, Welty M, Solomon P. Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report. Cannabis and Cannabinoid Research. 2017;2(1):160-166. doi:https://doi.org/10.1089/can.2017.0012

19. Kvamme SL, Pedersen MM, Rømer Thomsen K, Thylstrup B. Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample. Harm Reduction Journal. 2021;18(1). doi:https://doi.org/10.1186/s12954-021-00520-5

The information in this article and any included images or charts are for educational purposes only. This information is neither a substitute for, nor does it replace, professional legal advice or medical advice, diagnosis, or treatment. If you have any concerns or questions about laws, regulations, or your health, you should always consult with an attorney, physician or other licensed professional.

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