Dangerous
A second opioid and a lowered seizure threshold on top of a strong opioid.
Do this
Do not combine. Keep naloxone nearby.
Where the risk isTap for why
What to do
- Say what was taken and how much.Responders need it, and in most US states Good Samaritan laws protect both of you from drug possession charges when you call for an overdose.
- Unresponsive: put them on their side, tilt the head back, and stay until help arrives.Never leave someone alone to “sleep it off”.
- Give naloxone (Narcan) if you have it.It is sold over the counter in every US state and does no harm if opioids turn out not to be involved.
- Never Use Alone 1-800-484-3731Stays on the line and sends help if you stop responding.
- Full steps: what to do if it is already happeningOverdose signs, the recovery position, what to say on the call, and whether you can be charged for making it.
- Poison Control 1-800-222-1222Free and 24/7, for “is this bad?” before it becomes an emergency.
What “Dangerous” means
High risk of death or life-changing injury. Do not combine.
How the ratings workThe longer explanation
Tramadol adds a second opioid and a lowered seizure threshold to a strong one.
Sources (2)
- Hill R et al. The respiratory depressant effects of mitragynine are limited by its conversion to 7-OH mitragynine. Br J Pharmacol. 2022pmc.ncbi.nlm.nih.gov
- FDA recommends scheduling of 7-OH (7-hydroxymitragynine). HHS, July 2025hhs.gov
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Related combinations
7-OH withWhat not to mix with 7-OH →
Tramadol withWhat not to mix with Tramadol →
All combinations →Can you mix 7-OH and Tramadol?
MixSafe rates mixing 7-OH and Tramadol as "Dangerous" — high risk of death or life-changing injury. Do not combine. Source: MixSafe research. Educational information, not medical advice.