Medical Marijuana and Buddhism

Below is the full text submitted for the article "How do Buddhists view medical marijuana?" in The Medical Marijuana Review Posted on January 2, 2014 by Dave Gordon in Feature Story. http://medireview.com/2014/01/how-do-buddhists-view-medical-marijuana/#.UuffYxb0DUT  

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Medical Marijuana and Buddhism
Sean Hillman, PhD student Religion/Bioethics/South Asian Studies
University of Toronto
Dec. 10, 2013    

     Since Buddhism is multiple, it is difficult to establish an authoritative stance on many issues. My thoughts on this particular subject are merely my opinion, informed by the study and practice of Buddhist discipline texts and caregiving in hospice and hospital settings. His Holiness the Dalai Lama's recent statement on the medicinal use of marijuana points to one of the central concerns when determining the appropriateness of Buddhists using certain medications: whether it is mood/mind/consciousness altering or not. As with other such statements on major issues, I think this is meant to address Buddhist vow-holders (householders and monastics who have chosen to keep ethical precepts, including to abstain from intoxicants) in particular and is not best served as a blanket statement applying to all since what people choose to ingest is their private business not subject to Buddhist religious scrutiny. What the individual ingests is, however, indeed under the scrutiny of the law and the health care professional that is responsible for suggesting courses of treatment for the patient. A similar tension between treating illness versus altering the mind occurs regularly with front-line Emergency Room professionals when drug addicts seek treatment. It is difficult to tease out a valid need for somatic pain relief from simple drug-seeking, and many health studies show that this complexity results in an under-treatment of pain in relation to this demographic. The concern with intoxicating side-effects when using opioids, such as morphine for example, is often based on a misunderstanding of pain management. Simply, when the pain at hand is addressed without any intoxicating side-effects, medication has been administered correctly and pain management is effective. Finding the best delivery method and dosage are the challenges. If there is intolerable pain, it is not yet managed. Going beyond this threshold can lead to side-effects, including drowsiness and even respiratory failure. This is often cited in articles on Buddhism and health care as the reason why Buddhist patients might refuse pain management when nearing death for fear that they will not be able to die with conscious awareness and thus detrimentally affect their rebirth. Earlier in my career as a Buddhist, especially while a monastic, I would likely have similarly refused pain control meds. Now, however, I know that there are circumstances in which medicinal pain management can be done properly and actually serve as an essential component for assisting the Buddhist with intractable pain to die more comfortably without loss of awareness.      

     If we apply pain management logic to the use of medical marijuana by Buddhist vow-holders, I would ask if it is possible to treat illness by this means without side-effects. It is well established that chronic cannabis users develop a tolerance which requires a certain amount to normalize, or level-out to counteract possible unwanted emotional states such as depression or agitation, and have increasing difficulty in achieving a high. In such cases of dependency it seems possible to use the drug without altering the mind. But what about someone who is not dependent and is prescribed medical marijuana for pain associated with cancer, as it often is, or asthma? And what about the differences between delivery methods, such as edibles versus smoking, or smoking versus vaporizing? I would say that in comparison to opioids where pain management can be achieved without side-effects, the side-effects from medical marijuana are more difficult to avoid. This may simply be a matter of delivery and dosage and not inherent in the chemistry of the drug. It is interesting that, as far as I am aware, patients themselves are exclusively responsible for self-administering the marijuana prescribed to them. Envision patients sitting with an IV being administered THC right into the blood-stream, or being given THC pills. The degree to which we find this fanciful might be commensurate with the degree to which we have trouble disentangling the botanical as a therapeutic intervention from it as a recreational drug.          

     If Buddhist goals are the development of a calmly stabilized mind with insight into reality and a heart concerned deeply with others for their own sake, then actions that hinder these processes, such as altering the mind with substances and potentially increasing delusions and emotional afflictions (while breaking vows to do so), are obstacles on the various Buddhist paths. Here I distinguish between Buddhists who hold a vow to refrain from intoxicants and those who do not. Even if a vow-holder would refrain from using medical marijuana if they could not establish for certain that their complaint could be successfully addressed without mood/mind/consciousness altering side-effects, this does not mean that non-vow-holding Buddhists do not use marijuana both recreationally and therapeutically. There is nobody disciplining Buddhists except for the practitioner themselves, and the natural law of karma is considered to operate whether the practitioner is aware or concerned with the process or not.          

     I have entirely avoided discussion of tantric traditions where typically forbidden substances are consumed as a subversive against pollution taboos and to demonstrate transcendence of materiality. I have also chosen to bracket the occasions of sacred usage of botanicals explicitly for spiritual purposes, such as with ayahuasca during ceremony. Both of these areas of inquiry can potentially add to the discourse around medical marijuana and Buddhism.

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Sat. Apr. 5

Zysk's study of ancient Indian medicine in Buddhist monastic and Hindu texts shows that intoxicants were at times doctrinally acceptable (by way of sanction by the Buddha) for use in treating monastics suffering from certain conditions despite the seeming contradiction with the vow to abstain from intoxicants. There are two examples found in the case stories of disease treatment in the medicine section of the Theravada Pali monastic code.
(1)
"Affictions of Wind: The monk Pilindavaccha suffered from the affliction of wind (vātābādha). On the recommendation of physicians (vejja, Skt. vaidya) oil (tela) was decocted, combined with a weakened intoxicating drink (majja, Skt. mada, madya), and given to the monk. If the drink was too strong, an oily massage (abbhañjana) was to be administered (Zysk 1991: 92)."
(2)
"Wind in the Abdomen: The affliction of wind in the abdomen (udaravātā) is discussed two times in the Vinaya. In the first case, a monk was cured by giving a mixture of salt and a type of astringent barley wine (loṇasovīraka) to drink. This treatment was allowed to the sick (gilāna), but for those not sick (agilāna), it was permitted as a drink (pāna) when mixed with water (udakasambhinna) (Zysk 1991: 100)."
It is interesting to note that mention of the medicinal use of intoxicating substances in both cases does not have explicit reference to neutralizing the intoxicating potential, but merely calls for a 'weakened' form of the drink for the sick monastic in the first case but not in the second, and dilution of the barely wine concoction for the healthy monastic. We could assume that the 'weakened' form is prepared by dilution, but that is not entirely made clear. Nor is it clear that the 'weakened' form of the first concoction is made to no longer have the potential to cause intoxication. The many examples of special exceptions for sickness in the monastic codes, such as flexibility around eating after midday, might explain the specific use of concoctions with intoxicants for sick monastics but why would healthy monks take a diluted form of the second concoction? We could assume that the need for dilution in this case would be to prevent intoxication, and that healthy monastics would be taking it as a prophylactic treatment (not just for the sake of it), but neither of these assumptions have explicit textual support. Buddhaghosa's Vishuddhimagga ("Path of Purification"), which Zysk relies on in his study, might help clarify these points. In his commentary on these cases Zysk doesn't seem to find this fascinating tension between the competing principles in the monastic code of maintaining clear-mindedness versus treating illness at all noteworthy. I also wonder what this "intoxicating drink (majja, Skt. mada, madya)" is, and if it is related to honey based on linguistic similarity. I will be looking into it.