Marijuana as an Analgesic
It’s wrong to intend intoxication either as an end or a means. So it is impermissible to intend intoxication as a means to relieve pain. It is, however, permissible to foresee intoxication as an unintended side-effect of one’s action.
Still, given that intoxication is a wrong, one must judge whether intoxication is proportional to the good of pain relief. If it is proportional, then it can be justified. But proportionality does demand that one seek out non-intoxicating alternatives if feasible.
So the question is this: Do the anesthetic properties of marijuana work by intoxicating the users? If so, then the intoxication is being used as a means to relieve pain, and would be impermissible. If, instead, the anesthetic properties are achieved by some non-intoxicating mechanism of marijuana, then the intoxication could classify as an unintended foreseen consequence.
There’s debate about whether marijuana has any pain relieving properties at all. From a peer reviewed article: “Despite the increased demand for cannabinoids among individuals with persistent pain, the evidence is deemed low, or very low, for analgesic efficacy.” This study goes on to demonstrate that the analgesic efficacy of marijuana can plausibly be attributed to the placebo effect.
THC is the primary psychoactive ingredient of marijuana. CBD may have some psychoactive effects, but significantly less than THC. Some argue that CBD is the primary vehicle for pain relief, given its purported anti-inflammatory properties. If this is true, then proportionality would demand isolating CBD from the intoxicating effects of THC. I have a strong suspicion that many marijuana users would no longer take the drug if it were stripped of its intoxicating powers.
One significant, but rather limited study, strongly suggests that marijuana’s purported analgesic properties are in fact attributable to THC’s intoxicating effect: “Brain imaging shows little reduction in the brain regions that code for the sensation of pain, which is what we tend to see with drugs like opiates. Instead cannabis appears to mainly affect the emotional reaction to pain in a highly variable way.” If this is right, then THC cannot be permissibly used as an analgesic, as intoxication is being used as a means to relieve (or distract from) the pain. Question: Would marijuana achieve its goal if its intoxicating effect (i.e., its harm to rationality) were entirely removed? If the answer isn't "yes, it would achieve its goal even if the intoxication were removed," then it's prohibited.
Much of the reasoning in this essay applies to other types of intoxicating pain relievers. Proportionality demands that we search out, as far as is feasible, alternative pain relievers that do not intoxicate their users. Thankfully, such alternatives do exist: Localized anesthesia, steroids such as corticosteroids and gabapentinoids, and NSAIDs. There are also developing technologies that show promise in pain management: Radiofrequency ablation - which works by inserting a needle into a nerve, and can provide pain relief for up to a year. Nerve blocks and the use of transcutaneous nerve stimulation. Pain pumps also allow for specialized delivery to problem areas without affecting the mind.
Sources:
THC vs. CBD: What's the Difference?
Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action - PMC
Brain imaging insight into cannabis as a pain killer | University of Oxford
Analgesic mechanisms of gabapentinoids and effects in experimental pain models: a narrative review
Marijuana as an Anxiety Medication?
Limited studies suggest that CBD is largely responsible for any anxiety reducing effects of cannabis. The response of individuals is highly variable, however, with some reporting increased anxiety. THC, in small doses, appears to decrease anxiety but increases it at higher doses. CBD does not appear to cause anxiety, even at higher doses. Neither THC or CBD seem to be good at managing anxiety in the long term, possibly due to the increased tolerance of users - plus, cannabis poses significant risks with long term use. This long term ineffectiveness for anxiety relief may underlie the strong correlation of regular cannabis users with anxiety disorders, with long term users at a 35% higher risk of a mental disorder. Some studies suggest that treating anxiety with cannabis leads to increased depression. Given that CBD is not psychoactive, it may be justifiable as a means of treating anxiety in the short term. Still, given the success of alternative treatments for anxiety such as SSRIs, exercise, and therapy, which have long-term success, CBD doesn't seem like it should be a first choice. "Developing better tools to manage stress and anxiety makes the most sense. Developing better coping mechanisms is likely to be especially beneficial for individuals using risky substances" and "In addition, marijuana doesn’t appear to offer the same long-term effects as other anxiety treatments, including psychotherapy or medication. Using marijuana may offer some much-needed temporary relief, but it’s not a long-term treatment option."
Sources:
Effects of Marijuana on Mental Health: Anxiety Disorders
Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders - PMC
Marijuana and Anxiety: A Good or Bad Match?
Cannabis and anxiety: What's the link?
Know the Negative Effects and Risks of Marijuana Use | SAMHSA
Medicinal Marijuana, Stress, Anxiety, and Depression: Primum non nocere - PMC
Cannabis, a cause for anxiety? A critical appraisal of the anxiogenic and anxiolytic properties
Cannabis use and the risk of developing a psychotic disorder - PMC
Marijuana and Tolerance
Studies have reported conflicting results on whether regular cannabis users develop tolerance over time. Some have failed to show that marijuana has an effect on cognitive performance for regular users, while other studies show that regular users are impaired in a broad range of cognitive domains. A good explanation of this discrepancy is that tolerance could unequally affect different performance domains. Tolerance is thus relative to a specific domain. Many studies indicate that marijuana has a less pronounced subjective effect on regular users versus non regular users. In other words, subjective experience of intoxication in regular users decreases with extended use. Further, tolerance in regards to cognitive function varies in regard to the specific tasks, with some tasks showing decreased impairment with extended marijuana use and other tasks being insensitive to extended use or not.
Regular users, upon ingesting cannabis, did not show significant impairment in sustained attention, psychomotor ability, or reaction times. But regular users did not significantly differ from non-regular users in the following domains: Distractibility, executive function, impulse control, working memory, risk-taking, and hand-eye coordination. Regular users and nonregular users suffered from similar impairment in the Digit-Symbol Substitution Test, for example.
Sources:
Cannabis Use and the Development of Tolerance: A Systematic Review of Human Evidence
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