Dear Drugs-Forum readers: We are a small non-profit that runs one of the most read drug information & addiction help websites in the world. We serve over 3 million readers per month, and have costs like all popular websites: servers, hosting, licenses and software. To protect our independence we do not run ads. We take no government funds. We run on donations which average $25. If everyone reading this would donate $5 then this fund raiser would be done in an hour. If Drugs-Forum is useful to you, take one minute to keep it online another year by donating whatever you can today. Donations are currently not sufficient to pay our bills and keep the site up. Your help is most welcome. Thank you.
SWIM did a quick search and there didn't seem to be a thread about Tramadol and Marijuana yet... So here it is!
SWIM has experienced intense pleasure with Tramadol and Marijuana. He first took the Tram. and as they were kicking in began to smoke. They have amazing synergy, so the high lasts for a very long time.
SWIM has also used antacids for propentiating the Tramadol while combining Marijuana and had no problems at all. Just hours of pleasure.
Be sure never to combine anything with Tramadol you are not supposed to. I have not posted 50 times yet so I cannot leave an interaction link. Be sure to google any drugs you intend on taking with Tramadol. It has many dangerous interactions.
Plus, studies show that marijuana can prevent or lessen the severity of seizures.Just in case...
Tigey is a bit worried by this advice. While yes, cannabis has been shown to reduce seizure risk in some populations, Tramadol carries increased risk of seizure, with incidence of seizure found to be independent of dose in an Iranian study (Talaie et al., 2009 - published in Journal of Medical Toxicology, 5(2), 63-67).
Further to that, Tramadol has been shown to increase the risk of seratonin syndrome with SSRI's and pretty much anything else that decreases seratonin levels. McGill University and University of California studies published in 2007 showed that while cannabis in small quantities increased seratonin levels, in large quantitites it dropped seratonin levels (and fyi, also increases pain levels - for those who're thinking of taking the two together under MMJ+Tramadol prescriptions).
To quote from 'Alcohol and Marijuana: Effects on Epilepsy and Use by Patients with Epilepsy' (Gordon & Devinsky, 2001 Epilepsia, 42(10), 1266-1272):
The effects of THC on seizure threshold vary widely between studies that provide conflicting results (49,53). THC has both proconvulsant and anticonvulsant effects depending on dose, seizure model, and factors of seizure initiation versus seizure spread (39). THC has an anticonvulsant effect in models with rapidly evoked tonic discharges, utilizing post-tetanic potential for recruitment. In animal models of epilepsy, THC is effective against some forms of partial and generalized convulsive seizures. However, in animal models of genetic and absence epilepsy and other models of partial epilepsy, THC has proconvulsant effects. Animal studies also document a “rebound” effect to THC (54–56). After a single exposure to THC, the withdrawal phase enhanced CNS excitability, resulting in increased susceptibility to electrical-induced convulsions (55). This withdrawal hyperexcitability suggests that in susceptible patients, marijuana use may provoke withdrawal seizures (56).
Epilepsy Ontario said (website, 2011):
"Dependable documentation of the effectiveness of Cannabis sativa as an antiepileptic medication is severely limited at this time.
Some accounts show a reduction in seizure frequency and/or severity for some people with epilepsy. Whether this is due to anticonvulsant properties of cannabis or to a reduction in physical and/or psychological stress levels is not fully known and cannot be clarified without further comprehensive scientific scrutiny...
Like any drug, cannabis probably has potential to both harm and heal. Without bone-fide scientific investigation and evaluation, the efficacy of Cannabis sativa as an antiepileptic drug cannot be safely or surely ascertained....
Since THC has dual effects and there are unknown properties of marijuana, marijuana is NOT recommended for people with epilepsy.
Reliable documentation of the effectiveness of marijuana as an anti-epileptic medication is extremely limited at this time. While some accounts show a reduction in seizure frequency and/or severity in some people who have epilepsy, others suggest that marijuana may actually trigger seizures. Further investigation is needed to determine the effectiveness and side effects of cannabis as an anti-seizure drug."
An Australian study said:
Tramadol is the most frequently suspected cause of provoked seizures
Labate and colleagues note that tramadol is the most frequently suspected cause of provoked seizures at their First Seizure Clinic.
Early in 2003, the Adverse Drug Reactions Advisory Committee (ADRAC) reported to Australian prescribers the results of the first 4 years of experience with tramadol in Australia.2 At the time, ADRAC noted that 26 cases of convulsions had been reported among a total of 354 reports on tramadol.
Basically, cannabis can in some individuals, on it's own, increase the seizure threshold in seizure prone individuals (including myself). In others, it can lower the seizure threshold. This appears to depend upon type of seizure and potency + amount of cannabis, from studies to date. Most studies showing a protective effect were done with induced seizures and with very small amounts of THC - it may be that some compounds present in smoked joints do other things.
So basically, combining the medication which is most likely to cause you a seizure if you haven't had one before with something that can make seizures more likely is potentially an unsafe way of taking both drugs. For that matter, I'd suggest taking tramadol around other people if this is your drug of choice - fitting out or even having an absence seizure for the first time is a scary and severely unpleasant experience I wouldn't wish on anyone*, but it's much better if someone else is around to help, and that they know potential side effects and OD effects of the drug you're taking.
The fact that weed potentiates tramadol in some individuals should be a clear indication that it can potentiate not only the high but also complications of tramadol use in some individuals.
all the best,
Your friendly 'safety first, steak second' tiger.
* if someone does fit out, drop and start twitching (what used to be called 'grand mal' and is now called 'tonic-clonic'), grab them a pillow/something soft to put under their head - don't restrain them. Get anything sharp or hard out of their way ideally without moving them, and if it's lasting more than 5 minutes, is their first seizure, or they go from seizure to seizure without coming round first, call an ambulance. Paramedics will almost never (I'd say never but there's always one) care about recreational drug use, they're just there to help and that's all they'll be focusing on. While it's very rare that someone will have an obstructed airway (and the tounge swallowing thing is pretty much a myth), if they've just eaten or are on a whitey/OD when they fit, puking is more likely and more dangerous, but will usually happen when consciousness comes. Don't give food or drink til the person is fully conscious. As they ease up, move them onto their left hand side in what you can remember of the recovery position , and try to be an easy-focusing distance away to reassure them as they come round. Also, if you're freaked out, it's better to call for help than look stuff up on the internet when you can't remember this advice. You can always cancel help once you've called for it.
Last edited by Tigey; 13-11-2011 at 14:44.
Reason: missed an [/i] off the seizure info.
Thanks and no worries always nice to find someone who's okay with critique of post and doesn't take as critique of person.
Thanks also for clarifying. I was happy that you posted about seizures as it gave me the nudge to post about both issues - tramadol being awesomely seizureful and also weed use having odd results in seizure studies.
From Australian Prescriber via St. Vincent's hospital - I've trimmed bits to avoid over-quoting (want it to be fair-use, but think it's a public bulletin anyhow). Emphasis is mine:
Since tramadol was marketed in Australia in late 1998 its use has increased dramatically. While there is a large amount of information supporting tramadol’s effectiveness for pain, there is an increasingly large body of evidence from post-marketing surveillance showing there are problems. In 1999 there were 19 reports of adverse events, while in 2003 there were 286 reports. As of March 2004 the Australian Adverse Drug Reactions Advisory Committee (ADRAC) has received 726 reports of adverse events associated with tramadol, detailing 1922 reactions. In 453 of the reports, tramadol was the sole suspected drug. These reactions suggest that the decision to prescribe tramadol should be carefully considered.
Tramadol is a centrally acting analgesic. Structurally it is not an opiate, but it exhibits some opioid characteristics. Like opioids it binds to µ receptors, although very weakly (binding affinity is 10 times less than codeine and 6000 times less than morphine). Like codeine, tramadol is metabolised via the CYP2D6 isoenzyme of cytochrome P450 to an active metabolite which binds to µ receptors. Patients who metabolise drugs poorly via CYP2D6 (about 7% of Caucasians) may get less benefit from tramadol [...].
The analgesic effects of tramadol are not completely reversed by [...] naloxone and some patients who do not respond to codeine do respond to tramadol. This suggests that tramadol has additional mechanisms of action. Tramadol inhibits reuptake of serotonin and noradrenaline and this probably contributes to its analgesic effects.
[...]in postoperative and post-trauma pain, tramadol 100 mg intramuscularly or intravenously was equivalent to 5–10 mg of morphine. However, in severe pain associated with either surgery or cancer, morphine was more effective than tramadol and remains the drug of choice. In acute and chronic non-malignant pain, oral tramadol 100 mg is comparable to a combination of paracetamol and codeine (1000 mg/60 mg). [...] few direct comparisons of tramadol with non-steroidal anti-inflammatory drugs, but efficacy appears to be similar.
When choosing between equally effective analgesics, relative safety is important. In the case of tramadol, adverse effects are common and sometimes serious. Tramadol binds weakly to opioid receptors, so at normal doses constipation and respiratory depression occur less frequently than with opioids. However, these effects can, and do, occur at higher doses. Tramadol is metabolised in the liver and excreted by the kidneys, so doses should be adjusted in patients with impaired liver or kidney function, and in the elderly.5
Other opioid-like effects occur commonly at normal doses, including nausea, vomiting, dizziness and confusion. A major problem is dizziness which can contribute to falls in at-risk patients. Dizziness appears in 13% of the reports received by ADRAC.
Seizures have been reported with tramadol at normal doses. ADRAC has received 66 reports involving convulsions and in 27 tramadol was the sole suspected drug. Tramadol should be avoided in patients with epilepsy and used cautiously in patients taking medications which lower the threshold for seizures, including tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), major tranquillisers, bupropion and opioids. Other serious adverse effects include hallucinations, hypertension and hypersensitivity reactions.
Many interactions with tramadol have been identified. Some involve changes in metabolism. For example, carbamazepine reduces the analgesic effect of tramadol by increasing its metabolism (presumably via CYP3A4). Drugs which inhibit CYP2D6 activity (such as some SSRIs, quinidine, phenothiazines, some protease inhibitors) will inhibit conversion to the active metabolite.
Interactions may involve enhanced drug activity at receptor sites. A severe serotonin syndrome may occur when tramadol is combined with other drugs which also increase serotonin activity. Such drugs include SSRIs, moclobemide and other monoamine oxidase inhibitors, tricyclic antidepressants, sibutramine, St John’s wort, lithium and pethidine. ADRAC has received 35 reports of serotonin syndrome in association with tramadol, usually in combination with other serotonergic drugs.
In some cases the mechanism of interaction is unclear. For example, tramadol may increase the effects of warfarin. The patient’s INR should therefore be carefully monitored.
While the forum guidelines discourage linking out in favour of info in posts, the rest of this article is at: Australian Prescriber and is well worth a read.
Specifically, drugs.com's drug interactions database says this about the reaction between Marinol (synthetic cannabis) and Tramadol:
MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects [...].
MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression.[...]
It's also worth noting that in rat brains, Cannabigerol (CBT), which is the biosynthetic precursor of CBC, CBD and THC, inhibits the uptake of serotonin, as does THC (more strongly, in fact). (Source: Russo, E., Cannabis therapeutics in HIV/AIDS, 108.). This means that the info on Tramadol and SSRI's below may also be worth being aware of:
MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors [...] may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.
MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk.[...]
Tramadol is one of the most 'interactive' drugs - it has more than 600 known drug interactions, and as such, perceived benefits in creating a recreational drug cocktail may be outweighed by the risk of unexpected side-effects, especially in cases of 'laced weed', for instance Tigey's friend Mr. Horse's old favourite, PCP-dusted weed.
tramadol and speed meth..seems to be a bad mix...with serotonin syndrom like....
And buprenorphine and LSD was looking to make a similir problem...between brain receptors...
try it with care if gonna do such kind of mixes...bad feeelings times..
twizz mixes this concoction a fair bit: a few tram., then a joint... another... etc. It's funny 'cause the girl in question often finds a fair bit 'o' tram will make her extremely hyper, though with weed, she'll sometimes need a little snooze (depends on the draw and a million other factors, though). Although, she's also on SSRIs (citalopram, 20mg) but not a particularly high dose and has been fortunate enough to never experience a seizure (despite taking quite stupid amounts in past...), BUT - has experienced hallucinations as a result of this combination, which was strange, surreal, unexpected and quite dazzling. And another thing she'll say for it, which is probably restricted somewhat to her (as everything effects everyone differently in different scenarios and all that/too thick to consider more than a couple of variables), such a combination seems to decrease tram. sickness (which she'd get after the euphoria/good mood had faded and the next day risen)