Ruling issued by: Sh. Basem
Date issued: October 9, 2018
RULING/FATAWA: The medicinal use of marijuana and its derivatives is only allowed as an alternative treatment option only when all other therapies have failed. Reasonable scientific evidence must support the treatment plan. It is obligatory, or fardh, to seek the advice of a licensed medical professional for a legal prescription of appropriate medicinal preparations along with a supporting treatment plan.
Interest in the Islamic rulings on the use of marijuana (cannabis) continues to grow, as more countries and states (in the US) are moving towards the legalization of the use of marijuana for recreational or medicinal use. Many adults ask about the use of marijuana for pain, epilepsy and mental disorders. More alarmingly, however, are the questions from parents asking about the use of cannabis for their kids. A recent example comes from parents asked if their 6-year-old child could use marijuana to help alleviate the symptoms of attention-deficit/hyperactivity disorder (ADHD) associated with autism. They complained other medications left their child with unwanted side effects.
A quick internet search on the ‘benefits’ of medical marijuana results in 100s of hits suggesting it is the magic remedy for all problems. If Elon Musk did it, it must be ok! Well, no, it is not always OK. It is now necessary to become familiar with the proposed uses of medical marijuana, the suggested benefits, and the Islamic perspective on it all.
Marijuana, the short story
Marijuana contains hundreds of molecules (cannabinoids) that may exercise physiological effects on humans. The two most important molecules are tetrahydrocannabinol (THC) and Cannabidiol (CBD). THC has psychoactive psychopharmaceutical, or psychotropic effects, meaning it can cause mental and neurological changes such as alterations in perception, mood, consciousness, cognition, or behavior. It is the culprit for the ‘feeling high’ effect of marijuana use. On the other hand, CBD is not psychoactive and may be isolated for other plants such as hemps. In the US, THC is available is a synthetic form in the prescription drug Dronabinol, which is approved by the Food and Drug Administration (FDA) as an appetite stimulant for people with AIDS and as an antiemetic (anti-nausea/vomiting) for cancer patients receiving chemotherapy[i]. CBD is approved by FDA as prescription drug called Epidiolex for some rare forms of childhood epilepsy.[ii] Other preparations are available in different countries.
Intoxicants and Islam
Like all mind-altering substances, marijuana is classified Islamically as an intoxicant. All intoxicants are considered, impermissible- haram. The prophet ﷺ said “every intoxicant is haram.” [iii] A famous juristic principle dictates that “whatever intoxicates in large quantities, then a small quantity of it is forbidden- haram.”[iv] Therefore, there is no validity to the argument some make that they do not get intoxicated using small amounts of certain intoxicants.
In general, any forbidden substance such as intoxicants is permissible in exceptional circumstances for legitimate purposes such as for therapeutic needs. This exceptional use is contingent on the following criteria:
- There is reasonable evidence that intoxicant has therapeutic efficacy.
- There is lack of permissible alternative options.
- The benefits of the intoxicant use outweigh its risks.
Medicinal Marijuana an Intoxicant?
Now, consider the above criteria as it relates to the issue of medicinal marijuana.
Firstly, the evidence supporting the therapeutic use of marijuana should be assessed carefully, considering scientific and medical standards. Anecdotes and personal experience are not considered reliable evidence. A comprehensive review of the available data on medical marijuana use for different conditions published by Mouhamed et al (2018) serves as a credible and easy resource with a quick summary of the available evidence[v].
There appears to be reasonable evidence for the efficacy of CBD use in some types of epilepsy and some types of movement disease such as Parkinson’s disease. THC also has reasonable evidence, alone or mixed with CBD, to be effective for specific pain conditions such as nerve injury-related pain. As indicated earlier, there is acceptable evidence to support the use of THC as an appetite stimulant and to treat nausea and vomiting in cancer patients on chemotherapy.
Secondly, even when evidence supports the medicinal use of marijuana as an alternative therapy, Islamic justification for its use is only satisfied after all other alternative therapy options have failed. This same rule applies within the practice of medicine (see previous paper). Most of the medical conditions for which people seek marijuana have very well-established treatment plans with track records and evidence for efficacy and safety.
Before trying to source medicinal marijuana, advice from an experienced medical professional should be sought to rule out conventional treatments or other known alternative treatments. Only a licensed medical professional can prescribe medical marijuana as part of a comprehensive treatment plan. Individuals are not qualified to make this judgement. No one should self-medicate or experiment with use of marijuana without the guidance of a medical professional. This point is particularly relevant for parents seeking medical treatment for children in their care.
Obligatory ‘Fardh’ Requirement
It is ‘fardh’ or obligatory to seek professional medical advice to rule in or out the use of medicinal marijuana. If medicinal marijuana is deemed permissible, only pharmaceutical preparations of marijuana may be used. Cigarette and other “smoked” forms are impermissible.
Thirdly, the use of medicinal marijuana should have more benefits than risks. The use of medical marijuana has an endless list of side effects, physical and mental. These risks can be significant. Some early evidence even suggests smoking marijuana increased the risk of certain cancers. It is nothing but a myth to consider smoking marijuana safer than tobacco. The additive effect of marijuana and its long-term damaging effect is obviously a major concern and should be considered when making the decision to permit its use. This is more relevant in people with mental disorders or people with know history of substance abuse. Since it lacks the psychoactive effect, CBD in its pure form does not carry the concern of addiction. That may be considered criminal in some states.
[i] FDA database;
[ii] Mead, A. The legal status of cannabis (marijuana) and cannabidiol (CBD) under U.S. Law. Epilepsy and Behavior. 2017; 70: 288–291.
[iii] Sahih Muslim # 3740.
[iv] Ibn Majah # 3392.
[v] Mouhamed Y et al. Therapeutic potential of medicinal marijuana: an educational primer for health care professionals. Drug Healthc Patient Saf. 2018; 10: 45–66. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/pdf/ptj4203180.pdf