This is a frequently asked question, and the answer is not simple. There are interactions between cannabis and opioids, and Tramadol is a synthetic opioid. The clinical significance of these interactions is dose-dependent, and also affected by the presence of other medications or underlying medical conditions. For most people, Tramadol and cannabis are well tolerated together, and many patients have found using cannabis allows reduction of their Tramadol dose without sacraficing pain relief. But effects are additive, just as with taking alcohol and opioids together. In some patients combining cannabis and Tramadol leads to dizziness or other adverse effects. Because Tramadol and cannabis share metabolism, in some people combining the two (especially with other drugs) increases their active blood levels, which is effectively like taking more. I'd summarize by saying that while combining cannabis and Tramadol is not contraindicated, I would start at very low doses and increase cautiously as tolerated.