Tramadol and Weed: Is It Safe to Take Both?

Doctors may prescribe tramadol to patients after surgery or a critical injury for pain. It's an opioid analgesic that works by changing how the brain perceives and responds to pain.

Chronic pain is a significant issue in the US. According to a CDC report from 2021, approximately 20.9% of US adults experienced chronic pain, and 6.9% suffered from high-impact chronic pain, which severely limits life or work activities​​.¹ 

Many people rely on the analgesic potential of cannabis to help manage pain. But should you combine tramadol and weed? There are concerns about potential interactions and side effects when mixing tramadol and THC, particularly since both can impact the central nervous system.

What is Tramadol?

Tramadol is an opioid analgesic medication primarily used to relieve pain. It manages moderate to moderately severe pain in post-surgery, following severe injury, or ongoing conditions like osteoarthritis.

Like other opioids, tramadol works on specific sites in the brain and spinal cord to block pain signals. However, it also affects chemicals in the brain, like serotonin and norepinephrine, which are involved in mood and response to pain. The liver metabolizes tramadol via an enzyme called CYP2D6. This conversion produces an active metabolite called M1, which is responsible for much of tramadol’s pain-relieving effects. 

This active metabolite, M1, has a higher affinity for the opiate receptor called the mu receptor than the inactive form of tramadol. Mu receptors mediate the effects of opioids.

Narcan® (naloxone) is a medication used to reverse the effects of opioid overdose by blocking opioid receptors. Unlike some other opioids, tramadol’s effects aren’t wholly reversed by naloxone.

Common side effects of tramadol include dizziness, nausea, constipation, headache, and drowsiness. Serious side effects can include respiratory depression, serotonin syndrome, and an increased risk of seizures. Tramadol also carries risks typical of opioids, such as dependency and addiction.² 

The generic name for tramadol is tramadol hydrochloride. In the US, it is available in both immediate and long-acting formulations, which may include the brand names Conzip®, Qdolo®, Rybix® ODT, Ryzolt®, Ultram®, and Ultram® ER.

Because of the potential side effects, including respiratory depression, patients should not use alcohol, benzodiazepines, or any other central nervous system depressants with tramadol. Your doctor will review any liver-metabolized medications you use to avoid serious drug interactions.

Tramadol is a potent medicine, usually prescribed when other painkillers like ibuprofen or localized CBD topical ointments aren’t effective enough.

Can You Take Weed With Tramadol? Are There Risks?

There is research on combining tramadol and marijuana for enhanced pain management. One study observed results from the introduction of cannabis to opioid chronic non-cancer pain management.³ 

Combining opiates like tramadol and weed may intensify side effects, including drowsiness and dizziness. There is a risk of more dangerous side effects, including sedation, confusion, or respiratory depression.

Since both tramadol and marijuana interact with the chemical messenger serotonin, there may be a slight risk of serotonin syndrome, a dangerous build-up of serotonin in the body. Serotonin syndrome may occur when combined with other medications affecting serotonin levels.

Individual effects vary when mixing opiates and cannabis, so it’s difficult to predict specific risks.

Are There Benefits to Taking Tramadol and Marijuana Together?

For pain relief, prescription tramadol works on moderate to severe pain, changing the body’s response to stimuli. THC (tetrahydrocannabinol) is the main active compound in cannabis. THC is known for its ability to alter mind states, but it also has properties that may alleviate pain and other symptoms.

The intersection of these two – tramadol and THC – may offer some advantages. Recent studies and anecdotal evidence suggest benefits both in chronic pain management and for challenges in opioid use.

The body has natural painkillers called endogenous opioids. Cannabinoids interact with the receptors for opioids in the nervous system, particularly in the pathways that first receive pain signals, called primary afferent pathways. By influencing these pathways, cannabinoids enhance the body’s natural pain-relief mechanisms. Research shows that their combined effect on pain relief could be greater than the sum of their individual effects. 

A pre-clinical study looked at the combined effect of cannabis and morphine, a potent opioid. Cannabis, acting as a CB1 receptor antagonist, blocks the pain sensation and strength in CB1 receptors. In the peripheral nervous system, outside the brain and spinal cord, morphine blocks inflammation-pain signaling.³ 

Researchers found solid evidence that cannabinoids and opioids work better together than separately. Out of 19 studies they looked at, 17 showed that these two types of drugs, used simultaneously, have a stronger combined effect on pain relief.

To illustrate, another study at a medical cannabis clinic observed 600 patients who were using opioids for pain relief over six months. With the introduction of cannabis, doctors noticed that 26% of these patients completely stopped using opioids, and another 55% reduced their opioid usage by 30%. This study suggests that medical cannabis might help some people to use fewer opioids or stop them altogether and might also be effective as a supplementary treatment alongside opioids in managing chronic pain.³

Can Weed Replace Tramadol?

Concerns over the side effects and dependency risks of opioids are significant public health issues, leading to a search for safer alternatives. 

Cannabis emerges as a worthy candidate, with both anecdotal and research studies showing its effectiveness in managing pain, with fewer side effects than opioids. For some, cannabis provides relief where other treatments fail, offering a new avenue for those struggling with ongoing pain conditions.

Many studies also show cannabis reduces the use of opioids in patients affected by chronic pain. One study conducted in 2018 followed 1,145 patients, with results indicating a substantial decrease in opioid use among cannabis users. Baseline opioid use by 28.1% of participants declined to 11.3% at a six-month follow-up. Furthermore, there was a notable 78% reduction in mean daily opioid doses over six months. These findings suggest that cannabis may play a role in reducing opioid dependence and dosage in pain management.⁴

What Other Cannabis Compounds Work for Pain?

The therapeutic effects of cannabis aren’t solely due to THC. Other compounds in cannabis, like CBD, terpenoids, and flavonoids, may help to enhance the effects of a cannabis product. Studies are shedding light on the role of other cannabinoids for pain relief, as well as the potential ability for certain terpenes to alleviate pain.

Apigenin, a flavonoid, reduces the production of TNF-α, an inflammation-causing cytokine. Apigenin can modulate THC effects, making them more tolerable and boosting anti-inflammatory benefits.⁵ 

CBD-based strains may also be an effective choice for inflammatory pain, such as autoimmune conditions or arthritis. Advantages of CBD include a lower risk of adverse effects like low energy or cognitive impairment that may arise with added THC. Patients recommend highly rated CBD-dominant strains for pain relief, like Medical Mass, CBG, OG, and Critical Mass. A balanced 1:1 THC:CBD oil mix resolves neuropathic pain that doesn’t respond well to other treatments.³ 

Cannabis or Tramadol – Which is Better for Pain Management?

The side effect profiles of tramadol and cannabis are markedly different. Tramadol can lead to side effects such as nausea, constipation, dizziness, and headaches. More severe risks include dependence, tolerance, and, in some cases, respiratory depression. Cannabis, while generally considered to have a safer profile, can induce symptoms that may include altered sensory perception, impaired motor skills, and short-term memory loss, particularly with THC-dominant strains.⁶ CBD is well tolerated but can interact with other medications.⁷

One of the most significant concerns with tramadol is the risk of dependency and addiction, a concern with opioid medicines. The high risk of addiction to opioids like tramadol contributes to the ongoing opioid crisis. Comparatively, cannabis has a lower risk of addiction. However, long-term or high THC levels can lead to cannabis use disorders for some people.⁸

The choice between either cannabis or tramadol, or a dual therapy approach of cannabis and tramadol, should consider the individual’s specific condition, response to treatment, and the risk of side effects or dependence. Your healthcare professional should be dialed in on any changes in pain medication therapy to help make an informed decision prioritizing safety and effectiveness.

Safety Tips for Combining Weed and Tramadol

If you decide to combine tramadol and weed for symptom relief for pain, here are some tips and precautions to consider.   

Check with your healthcare provider. Before combining these two substances, check with your doctor, especially if you are currently using tramadol.  Adjusting the dosage of tramadol when combined with medical cannabis may be necessary​​. Talk with your doctor about changes in your pain levels and tolerances.

Start Low and Go Slow. Starting with a low dose of weed and gradually increasing it allows you to monitor your body’s reaction and minimize side effects. If using CBD only, begin with 5-10 mg 1-2 times daily. Increase as needed, not to exceed 1,500mg per day. If using THC, 2.5 - 5 mg is recommended to start. (Use a measured dose of tinctures or edibles. For inhalables, 1-2 inhalations.) Allow the cannabis to take effect for 15-30 minutes (up to an hour with edibles).⁹ 

Care During Usage. While using tramadol and THC, it’s vital to stay hydrated. Avoid activities like driving that require alertness and coordination. Pay attention to your body’s responses since the combination can cause sleepiness, confusion, and impaired judgment. Older patients and those at risk of falling should note tramadol can cause dizziness or excessive drowsiness.

Symptoms to Watch For. Be vigilant for symptoms such as excessive drowsiness, confusion, difficulty breathing, or any signs of serotonin syndrome. Be aware of the increased risk of seizures, especially if the dosage of Tramadol is high.

References

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2. Dhesi M, Maldonado KA, Maani CV. Tramadol. In: StatPearls [Internet]. StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK537060/ ↩︎
3. MacCallum CA, Eadie L, Barr AM, Boivin M, Lu S. Practical Strategies Using Medical Cannabis to Reduce Harms Associated With Long Term Opioid Use in Chronic Pain. Frontiers in Pharmacology. 2021;12. doi:https://doi.org/10.3389/fphar.2021.633168 ↩︎
4. Lucas P, Boyd S, Milloy MJ ., Walsh Z. Cannabis Significantly Reduces the Use of Prescription Opioids and Improves Quality of Life in Authorized Patients: Results of a Large Prospective Study. Pain Medicine. 2020;22(3):727-739. doi:https://doi.org/10.1093/pm/pnaa396 ↩︎
5. McPartland JM, Russo EB. Cannabis and Cannabis Extracts. Journal of Cannabis Therapeutics. 2020;1(3-4):103-132. doi:https://doi.org/10.1300/j175v01n03_08 ↩︎
6. Turner AR, Spurling BC, Agrawal S. Marijuana Toxicity. In: StatPearls [Internet]. StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK430823/ ↩︎
7. Huestis MA, Solimini R, Pichini S, Pacifici R, Carlier J, Busardò FP. Cannabidiol Adverse Effects and Toxicity. Curr Neuropharmacol. 2019;17(10):974-989. doi:10.2174/1570159X17666190603171901 ↩︎
8. Connor JP, Stjepanović D, Le Foll B, Hoch E, Budney AJ, Hall WD. Cannabis use and cannabis use disorder. Nat Rev Dis Primers. 2021;7(1):16. Published 2021 Feb 25. doi:10.1038/s41572-021-00247-4 ↩︎
9. MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. European Journal of Internal Medicine. 2018;49(49):12-19. doi:https://doi.org/10.1016/j.ejim.2018.01.004 ↩︎

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.