Key Takeaways
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Tramadol is a prescription medication for certain types of pain, including after surgery or injury.
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Research into combining cannabis and tramadol is still limited, and potential side effects may be more likely when used together.
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Cannabis and tramadol both affect the central nervous system, which may raise safety concerns.
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.
Combining Cannabis and Tramadol: What the Latest Research Says
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.
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
Are You Considering Using Cannabis and Tramadol?
Combining cannabis with any substance or medication carries its own risks. Cannabis research is still in its earliest stages, and there is a lot that researchers still don't know. That leaves the door open for unexpected interactions with other substances. If you are considering combining cannabis with any other substance or medication, speak to your doctor for proper medical guidance.
Likewise, stopping the use of a prescribed medication can lead to unintended consequences. Many medications take time to build up in the body. Stopping suddenly can cause unpleasant and potentially serious or even fatal side effects. If you'd like to stop using or replace a medication, you need to follow the guidance of your medical provider to make any approved adjustments safely.
References
- Rikard SM, Strahan AE, Schmit KM, Guy GP Jr.. Chronic Pain Among Adults — United States, 2019–2021. MMWR Morb Mortal Wkly Rep 2023;72:379–385. DOI: http://dx.doi.org/10.15585/mmwr.mm7215a1 ↩︎
- Dhesi M, Maldonado KA, Maani CV. Tramadol. In: StatPearls [Internet]. StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK537060/ ↩︎
- 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 ↩︎
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.
