What about Medical Marijuana?

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Author: 
Jim Leffel

Introduction

Recreational marijuana use has been decisively rejected by Christians because of its psychoactive properties and tendency to perpetuate a lethargic and selfish lifestyle.  But as cannabis is increasingly being legalized for medical use, a new discussion is emerging within the church about whether or under what conditions its use would be appropriate.  This essay presents an overview of the key issues and suggests some practical guidelines for potential cannabis users and leaders who will need to provide a biblical response to them.

The Scientific Dimension

Medical cannabis has been prescribed for AIDS and cancer patients suffering from nausea and poor appetite because of their treatments.  This has been viewed largely, though not exclusively, as a palliative care option, or for the duration of chemotherapy, not for ongoing symptom control or treatment.  Since long-term use is not in view and few options exist for patients in this sorrowful condition, the benefits seem to some to outweigh the dangers (see Proverb 31:6-7).  There is a plausible analogy between opiates and cannabis.  Both substances are commonly abused, but could play an appropriate, if limited, medical role. 

Though there may be a case for medical cannabis in conditions like terminal cancer or AIDS, marijuana seems to be prescribed (where legal) or advocated for a growing number of real or perceived maladies.  In a society with an increasingly permissive view of marijuana, it is likely that almost any justification for its use will be accepted.  In a culture ravaged by drug abuse and addiction, this raises obvious problems for the church. 

Let’s consider as a case study the debate over medical cannabis and Crohn’s and severe Inflammatory Bowel Disease (IBD).  Recent claims have been made about the effective properties of cannabis (THC) in Crohn’s and IBD patients.  These claims should be taken seriously both because of the wide range of positive anecdotal testimony and from a sense of compassion that suffering people are experiencing real help. 

Two commonly cited studies illustrate the case for medical marijuana.  The first is an Israeli study published in the journal Clinical Gastroenterology and Hepatology  (Naftali, et. al.: 2012).  This study of 21 patients with Crohn’s Disease found that “complete remission” was achieved by 5 out of 11 subjects who smoked cannabis over an eight week period.  On this surface of it, this is a significant result.  However, there are seriously limiting factors to the study.  Eight weeks is not long enough to claim “complete remission,” unless by “remission” is meant cessation of reported bowel flair ups during the time participants smoked cannabis.  There were no follow up studies to demonstrate the long-term results of cannabis use.  The authors themselves conclude, “[T]he primary end point of the study (induction of remission) was not achieved...”  The crucial point is that short-term relief of symptoms occurred, but not the stronger claim of actual remission of the disease. 

A second study by Karen Wright (Wright, K., et al.: 2008) indicates that chemicals found in cannabis could prove an effective treatment for Crohn’s Disease, not just symptom relief.  She was able to demonstrate that naturally occurring compounds in the human intestines, endocannabinoids, increase the permeability of the intestinal lining during Crohn’s-related inflammation.  These compounds are chemically related to cannabis.  In a laboratory experiment, Wright isolated cannabinoids from marijuana which helped epithelial cells from the intestines to form tighter bonds with each other, resulting in a membrane barrier for intestinal tissue.  No human subjects were involved.  These results correspond to other studies (Izzo, et al: 2012; Capasso et al.: 2008).  But significantly, Wright noted, “What is also encouraging is that while THC has psychoactive properties and is responsible for the ‘high’ people experience when using cannabis, cannabidiol, which has also proved effective in restoring membrane integrity, does not possess such properties.”  This and related studies could be very promising since it offers a chemical basis for why some compounds in cannabis could help treat Crohn’s Disease.  Medications extracted from cannabis would not produce the psychoactive effect that is so central to objections surrounding medical marijuana.  However, a safe and effective medication is still a long way off and more studies will be needed to confirm these potentially promising findings.   

But the clinical research is by no means uniform in favor of medical marijuana for Crohn’s.  A recent study (Storr, et al.: 2014), raises serious questions about the safety of marijuana for Crohn’s patients.  This eight month study of 322 patients from the University of Calgary concludes, “Cannabis use provides symptom relief in patients with inflammatory bowel disease but is associated with worse disease prognosis in patients with Crohn’s disease.  The study warns, “Cannabis use was associated with higher risk of surgery in patients with Crohn’s disease.  Patients using cannabis should be cautioned about potential harm, until clinical trials evaluate efficacy and safety.” 

The problem in the mostly self-prescribed world of medical marijuana is that there are no standards for drug safety or clinically established data on its efficacy.  The stringent scientific standards applied to FDA approval for new drugs have not been applied to cannabis.  However, compounds extracted from cannabis, such as dronabinol (Marinol) have been FDA approved and have a limited but clear medicinal value.  Perhaps in the future, cannabis research will lead to the production of medications to reverse the pattern of intestinal degeneration of Crohn’s Disease, but that is yet to be seen.  Until then there are many safe and proven medications available on the market today to alleviate the effects of chronic diseases such as Crohn’s.  These treatments should all be fully explored before considering something as risky as medical cannabis.  It is unfortunate that marijuana is being approved by public vote, not by expert evaluation, in the way all other medications become available.

But to the person whose life is significantly diminished by chronic IBD/Crohn’s and related diseases, the risks may seem minimal compared to the benefit of symptom relief.  For this reason, it is crucial that medical marijuana as a treatment option is viewed from the broader context of the potential dangers THC poses and the presence of alternatives to cannabis for these conditions.

The pervasive assumption seems to be that there is no real down side to smoking marijuana even for purely recreational purposes.  But a recent study (Gilman, et. al.: 2014), published in the Journal of Neuroscience, indicates significant brain abnormalities even with casual (weekly) marijuana smoking.  The team from Harvard Medical School, Northwestern University, and Massachusetts General Hospital found that cannabis creates disruption of neural organization in the a priori regions of the nucleus of the accumbens, hypothalamus, and amygdala—centers of the brain associated with emotion and motivation.  The researchers conclude, “This study raises a strong challenge to the idea that casual marijuana use isn’t associated with bad consequences...  People think a little recreational use shouldn’t cause a problem, if someone is doing OK with work or school.  Our data directly says that is not the case.” These findings provide more grounds for the National Institute on Drug Abuse warning:  “Research shows marijuana may cause problems in daily life or make a person's existing problems worse. Heavy marijuana users generally report lower life satisfaction, poorer mental and physical health, more relationship problems, and less academic and career success compared to non-marijuana-using peers” (NIDA: 2014).

In addition to the numerous medications available to IBD/Crohn’s disease patients, every expert in gastroenterology is convinced that diet and exercise are critical to keeping symptoms at bay.  British Dietetic Association evidence-based guidelines for the dietary management of Crohn’s disease in adults’ states: “Crohn’s disease is a debilitating chronic inflammatory bowel disease.  Appropriate use of diet and nutritional therapy is integral to the overall management strategy of Crohn’s disease” (see Lee et. al.: 2013).  Self-prescribed and self-monitored marijuana use may actually be a barrier to long-term health by muting symptoms and removing the sense of urgency to develop and sustain a healthy lifestyle.  

The Pastoral Dimension

Like many issues facing contemporary society, marijuana use is never mentioned in the Bible.  For this reason, medical cannabis needs to be viewed from the perspective of principles relating to substance use and abuse.  Four important areas of biblical teaching relate. 

First, the Bible calls Christians to sobriety.  Since it is impossible to smoke marijuana without getting high, these passages have a direct application.  But why does sobriety matter?  1 Thessalonians 5:6-8 contrasts drunkenness and alertness.  Paul says, “let us be alert and sober... let us be sober, having put on the breastplate of faith, and love, and as a helmet, the hope of salvation.”  Sobriety is essential to exercise faith, love, and hope.  Being high dulls us to the moment by moment call to faith.  Being high dulls us to the pressing call to love and an awareness of the true needs of others.  Being high obscures the tangible reality of hope in the returning Christ.  Put simply, drunkenness is a barrier to the Holy Spirit’s filling:  “Do not get drunk with wine, for that is dissipation, but be filled with the Holy Spirit” (Ephesians 5:18). 

In a related text, Paul says, “but you, be sober in all things, endure hardship...” (2 Timothy 4:5).  Here, sobriety is viewed as a condition for endurance.  To be high or intoxicated creates lethargy.  To “fulfill your ministry,” demands the willingness to work through pain and discomfort.  Self-medicating, whether through alcohol abuse or cannabis, works against developing the kind of toughness required of the effective Christian worker.

A second, and clearly related principle, comes from the context of being in a spiritual battle.  Peter warns, “Be sober of spirit, be on the alert.  Your adversary the devil prowls around like a roaring lion seeking someone to devour” (1 Peter 5:8).  Since marijuana is a psychoactive substance, the mind will be compromised in the spiritual war our enemy wages.  Dulled, deceived, and dissipated, without our full faculties, Satan finds an easy target.  Perhaps this is why Paul includes pharmakeon, sorcery, as of the flesh (Galatians 5:20).  Psychoactive drugs were used in pagan worship and this text directly juxtaposes it to walking by the Spirit. 

Third, New Testament teaching on Christians obeying secular government and its laws relates to marijuana: “Every person is to be in subjection to the governing authorities... whoever resists authority has opposed the ordinances of God... it is necessary to be in subjection, not only because of wrath, but also for conscience sake...” (Romans 13:1,2,5).  The scripture calls Christians to live within the law, except when laws directly conflict with the expressed will of God.  So, for instance, Peter and John defied the civil authorities in continuing to openly preach the good news (Acts 4:19).  Paul frames this obedience as a matter of conscience, a moral issue.  Certainly how Christians relate to the secular state is both for the good of social cohesion and for the greater priority of our witness to non-Christians. 

There are traps that medical marijuana smokers risk falling into.  For instance, most employers require a drug test as a condition of employment.  Cannabis smokers will fail that test.  So there could easily be significant financial loss associated with medical marijuana.  Further, because of the way THC stays in the body, it is possible to be arrested for the equivalent of drunk driving even a week after smoking.  Ohio law states that it is illegal to drive a vehicle while under the influence of marijuana.  A level of 2 nanograms per milliliter of the driver’s blood is sufficient to establish impaired driving.  Prosecutors will not need to present proof of impairment in the driver’s faculties.  This is very serious for anyone using medical marijuana because the average blood THC level for them is 10-20 nanograms.  The reality is that medical marijuana users, legally, should not even be driving (see Ohio code 4511.19 Operating vehicle under the influence of alcohol or drugs—OVI).  These are very serious risks indeed.  People thinking about using marijuana should talk to a lawyer about potential legal dangers.

Fourth, drunkenness is serious enough to call for church discipline (1 Corinthians 5:11).  That’s pretty sobering!  Users of medical marijuana seek primarily the symptom relief THC brings, but as a psychoactive substance, the dissipating effect is also present.  A way of living that includes getting high seems clearly, on the surface, to be sufficient to remove someone from fellowship.  Particularly in a church context where people are trying to make a break from drug addiction, cannabis users who could be treated with other medications present an unedifying, compromising example that can easily undermine the walk of their weaker brothers and sisters. 

Drawing Some Conclusions

Addressing medical marijuana use in the home church is complex and often laden with deep emotion.  Each situation will bring its own complexities. Being sensitive to people who are in pain pulls us toward compassion.  Reading the scripture with honesty and integrity pulls us toward concern for obedience to God’s revealed will and the life-giving principles expressed by it.  Consider the following areas in the process of counseling medical cannabis users and the home church.

What is being treated?  Is it a physician-diagnosed condition?  If so, what are the treatment options?  Medical marijuana would have to be the last resort for all the reasons explored in this paper.  That means home church leaders will need to do some research.  But the onus falls to the cannabis user to explain why this is the only effective option available to them.  Getting the opinion of a Christian physician specializing in the relevant area would be valuable and should be pursued. 

Get the advice of other Christians with the same diagnosis.  It’s easy to argue that those not afflicted with a medical problem can’t relate.  On a certain level this is true.  But there are many people at Xenos who have learned how to deal with chronic disease victoriously without smoking marijuana.  Home church leaders should insist that prospective medical cannabis users meet with these people and seek practical counsel on how to deal with their problem in a godly way.  Would-be medical marijuana smokers should be called on to diligently follow the example of mature Christians in this area.  There is legitimate concern that with the attitudes toward marijuana in our culture, and people will seek relief in something that is dangerous and works against their long-term health and spiritual life. 

Study the available research and biblical texts together.  Are you and the person considering medical cannabis clear on all of the related issues?  Do you agree on the appropriate course of action?  Since this is an area of potential church discipline, make sure to draw the leadership team of the home church and the sphere into the process early on.  If the person decides to pursue smoking marijuana, you will need to make it clear what that choice involves in terms of their standing in the home church. 

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References to Related Publications

Capasso, R. et al.: Cannabidiol, extracted from Cannabis sativa, selectively inhibits inflammatory hypermotility in mice (2008: British Journal of Pharmacology)

Criminal Defense Lawyer.com.  Outline of definitions for impaired driving and penalties.

Gilman, J.M, et al.: Cannabis use is quantitatively associated with nucleus accumbens and amygdala abnormalities in young adult recreational users (2014: J. Neurosci.)

Izzo, A. et al.: Central and peripheral cannabinoid modulation of gastrointestinal transit in physiological states during the diarrhea induced by croton oil (2000: British Journal of Pharmacology)

Lee, J. et al., British Dietetic Association evidence-based guidelines for the dietary management of Crohn’s disease (2013: J Hum Nutr Diet.)

Lomer, M.c. et al.: Current practice in relation to nutritional assessment and dietary management of enteral nutrition in adults with Crohn’s disease (2013: The British Dietetic Association)

Naftali, T., et al.: Cannabis induces a clinical response in patients with Crohn’s disease: a prospective placebo-controlled study (2012: Clinical Gastroenterology and Hepatology)

Storr, M, et al., Cannabis use provides symptom relief in patients with inflammatory bowel disease but is associated with worse disease prognosis in patients with Crohn’s Disease (2014: Crohn’s and Colitis Foundation of America)

O’Mathuna, D. et al.: Should Christians Smoke Medical Marijuana? (2011: Christianity Today)

O’Mathuna, D.,  Ethics of Marijuana Use (2014: Family Research Council)

Ravikoff. A. et al.: Marijuana use patterns among patients with inflammatory disease (2013: National Center for Biotechnology Information)

Wright KL (2008) Cannabinoid (CB)-2 receptors in the gastrointestinal tract: a regulatory system in states of inflammation.  Br. J. Pharmacol. 153(2), 263-7