Drugs vs Medicine in the 5th Precept

Hi friends, this is a tangent from the good (but also frustrating for me) thread: Use of Drugs for Meditation. My main research question is whether anyone knows of writing that addresses the complexities of cross-cultural interpretation of the concepts “intoxicant” and “medicine” as they relate to the 5th precept.

Here’s my thinking in brief:

  1. The precept literally mentions only alcohol, and the Vinaya allows medicine that contains alcohol. So the principle seems to be that intoxication is unskillful but medicine is skillful, and the same substance can fit both those categories.

  2. Most contemporary teachers [I’m familiar with] commonly assume that the 5th precept applies to a wide range of intoxicants, but never list what substances they think it refers to. And most teachers [I’m familiar with] suggest that students continue with their usual medications, including psychological ones, and don’t consider them a violation of the precept.

  3. Nearly all substances called intoxicants also have medicinal uses. And what substances are placed in each category is different in different cultures, and also changes over time in the same culture. (This is true as well for the category “food,” which in many cultures contains substances that are intoxicating and/or sometimes medicinal, like caffeine, chocolate, and sugar.)

My conclusion so far is that many substances commonly thought of as intoxicants (like cannabis, opiates, stimulants, and psychedelics) also are recognized in many cultures as having medicinal uses, and so should logically be accepted as potentially skillful and allowed for those keeping the 5th precept IF discernment is truly used to determine the use as medicinal rather than intoxication.

That’s hard to assess, of course, and very hard to generalize about. It makes it a practice, which is what all the precepts are. I don’t see an external authority like government or doctors able to make this assessment free from political and cultural conditions, so would propose that discerning right medication here must be the purview only of the individual, like any practice, supported by intimate guides like a therapist or Dharma teacher.

If this makes sense, I think it would add a much-needed cultural competency to discussions of the precepts, and work against the tendency toward reductive or reactionary generalizations.

I’m interested in any sources I might reference on this, and anywhere my logic is faulty, especially around Vinaya or commentarial discussions of this I’m not aware of. Thank you!


For what it’s worth, my interpretation is that the 5th precept includes the consumption of any intoxicants that lead to heedlessness, because intoxication makes it impossible to keep the other four precepts.

“Heedlessness” means moral recklessness, disregard for the bounds between right and wrong.

If a substance has the potential to blur the lines between what is skilful or unskilful, wholesome or unwholesome, then it falls under the intention of this precept, be it drug or medicine, and should be avoided, especially if more skilful alternatives are available.


We are very fortunate to live at a time where we have proven efficacious medicines. I certainly hope that no one stops taking prescriptions because of that precept. I am pretty certain the Buddha was concerned about alcohol and opiates, not antidepressants, antibiotics, etc…

My understanding of the principle is as you say: about heedlessness. But when you say

the “any” leaves the question unanswered. People become heedless on sugar and caffeine every day, as well as on meds their doctors prescribed them. And people remain heedful on cannabis and mushrooms every day.

What if it’s the heedfulness that’s important to the principle, not the substance?

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I tend to slope in this direction.

Skillfulness, wholesomeness, mindfulness, and non-harm to self or others, this is the Buddhist path as I understand it, and I believe that anything that is harmful to our ability to upholding those values in our practice are to be avoided.


Buddha said very clearly how to approach things while practicing Dhamma, having it to either black or white is too extreme for humans so his resolution:

“If anyone were to say that just as a person does a deed, so is his experience is determined by it, and if this were true, then living the holy life would not be possible, there would be no opportunity for the overcoming of suffering. But if anyone were to say that a person does a deed that is to be experienced, so does he experience it, then living the holy life would be possible, there would be an opportunity for the ending of suffering. For instance, a small evil deed done by one person may be experienced here in this life or perhaps not at all. Now, what sort of person commits a small evil that takes him to hell? Take a person who is careless in the development of body, speech and mind. He has not developed wisdom, he is insignificant, he has not developed himself, his life is restricted, and he is miserable. Even a small evil deed may bring such a person to hell. Now, take the person who is careful in development of body, speech and mind, He has developed wisdom, he is not insignificant, he has developed himself, his life is unrestricted and he is immeasurable. For such a person, a small evil deed may be experienced here or perhaps not at all. Suppose someone throws a grain of salt into a little cup of water. That water would be undrinkable. And why? Because the amount of water is small. Now, suppose throws a grain salt in River Ganges. That water would not be undrinkable. And why? Because the amount of water is great”

also precepts are not to be kept so to speak but they should be automatic (sila) as we understand Dhamma. The only thing in terms of breaking precepts is not to keep them but do not break them on purpose, which many people seems to confuse.

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Can you please include a link or reference to your quote? Putting something in a block quote without linking to the reference makes it difficult to find.

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I will write up something with more references a bit later but…

The precept literally mentions surā­meraya­majja­pamāda­ṭ­ṭhānā which does not just mean alcoholic drinks, it appears to mean something along the lines of “drinking strong drinks until your so drunk you can’t stand”.

So it could be argued that the precept is really a precept against drunkenness as opposed to a wine with dinner.

I also notice that surā­meraya­majja­pamāda­ṭ­ṭhānā is just one of about 15 related terms with various spellings that seem to have no consistency across the canon.

I also note that many of the instances where they occur in DN appear to be late additions.

I also note that in the indisputably early sekka patipada sequence that appears to be the basis for the five precepts has

They refrain from injuring plants and seeds.
Bīja­gāma­bhūtagāma­samā­rambhā paṭivirato hoti …pe…

Where we would expect to see the alcohol rule.

In DA we do in fact find the alcohol rule mentioned instead of the plants and seeds one.

In the Vinaya, rather than being a profound offense entailing expulsion, as killing a person, stealing, sexual intercourse and lying about supernatural powers all are, drinking alcohol merely entails confession, and occurs waaay back in chapter 6, rather than at the beginning.

DN31 is probably the clearest discussion of drinking in the 4N that I am aware of (although I am no expert on AN) and gives a good sense of what it is speciffically that the problem is;

There are these six drawbacks of habitually drinking alcohol.
Cha khome, gahapatiputta, ādīnavā surā­meraya­majja­p­pamāda­ṭ­ṭhānā­nu­yo­ge­.
Immediate loss of wealth, promotion of quarrels, susceptibility to illness, disrepute, indecent exposure; and weakened wisdom is the sixth thing.
Sandiṭṭhikā dhanajāni, kalahappavaḍḍhanī, rogānaṁ āyatanaṁ, akittisañjananī, kopīnanidaṁsanī, paññāya dubbalikaraṇītveva chaṭṭhaṁ padaṁ bhavati.
These are the six drawbacks of habitually drinking alcohol.
Ime kho, gahapatiputta, cha ādīnavā surā­meraya­majja­p­pamāda­ṭ­ṭhānā­nu­yo­ge­.

So to summarize, the precepts seem late relative to the sekka patipada and the patimokkha. the wording of the 5th precept is very inconsistent and appears to have been inserted back in to DN, and even moreso into DA where is has replaced the harming plants and seeds rule, and finally the precept itself is not really analyzed or explained in the 4 Nikayas beyond the short formula but appears to imply not just alcohol but strong alcohol, drunk to excess in a habitual way.

There is a strong impulse amongst religious followers to try and find “definitive” guidance for every situation in their sacred scripture, this leads to a great deal of delusional belief and strongly expressed opinion masquerading as fact. I encourage you to look through the EBT’s and carefully compare what they actually say to what we are told they say, I think you will find that there is a fair amount of evidence to suggest that alcoholism was a rare an not particularly fundamental problem early in the dispensation that probably became more prominent as the religion became more involved in sedantry urban communities, hence the development of a focus on intoxication.

(ps, the VInaya link is well worth a read, dragons, fire breathing, cheeky monks tricking villagers into distilling liqueur, a monk with supernatural powers straight up paralytic drunk in front of the Buddha, and in the end all it entails is “confession”!)


In the medical system of the time, certian substances were considered “vehicles” for transporting medicine to the correct part of the body. Alcohol was one of those. So it wasn’t so much that alcohol itself was the medicine.

This also helps to understand the allowance that alcohol could be injested as long as you cant taste it.

Absolutes like “anything”, “always”, “never”, etc. can be troublesome: so if someone has a head injury, should they not be put into a medical coma to expedite and increase their chance of recovery? Next to death a coma is almost the pinnacle of heedlessness.

What about chemotherapeutic medications that can affect attentiveness and cause drowsiness? Always to be avoided?

Rather than the medicine, it’s the cetana, intention, that generates kammic consequences.
True, if a side effect reduces attentiveness, there could be a temporary reduction of heedfulness and an ability for deep practice. But without medication, some people might become permanently incapacitated and may die. And what does that do to their practice?

It is really interesting to me that the VInaya rules are much slacker than the five precepts, for example, a lay follower who swats a fly breaks the first precept, however a monk who shoots a bunch of crows with a bow and arrow, chops off their heads, and puts their heads on spikes (presumably as a warning to other crows?) because they “don’t like crows” only commits an offense entailing confession.

So again, in short, contemporary practitioners make the five precepts out to be some sort of complete moral code or system of ethics, but when they are mentioned in the EBT’s they seem more often to be things undertaken on sabbath days as a form of ritual purification and a kind of lay “mock-monasticism”, they are not consistently presented and show a quite notable divergence to the actual system of ethical conduct that was practiced at all times, that is the VInaya, by monastics.

So the idea that early Buddhism had a clear and straightforward position on psychedelics, or even moderate alcohol use is just false, as is the idea that undertaking the 5 precepts or the 8 precepts is in any way required to be a Buddhist, again, this is something that is bandied about now, but appears to have no basis in the EBT’s. (the precepts are praised by the Buddha in the EBT’s, as being greatly beneficial, but so is saving a quarter of your income, and plenty of other things that are sensible when taken in the spirit of common sense).


Pardon? Where are you getting this? Are you talking about:

if he is the first offender. ādikammikassāti.

If so, that is not what that means. It refers to the monk who did the offense the first time, not the first time an individual breaks a precept. It’s found in all(?) of the pāṭimokkha rules.


That’s a quote from sutta, I do not remember exactly which one as I’m saving important quotes for myself, I think it was AN I.249

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yes that is what I was referring too! thank you for your correction, I do get prone to hyperbole! :slight_smile:

I’ve removed the statement

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This is why it’s important to be very sure we know what we are talking about when it comes to Vinaya. It really is a specialty field that requires training. But on the internet, anyone can talk about it as if they were an expert. I’m not saying that lay people shouldn’t learn and discuss the Vinaya. However, it should always be done with caution.


Thank you, @josephzizys — these are exactly the kind of references I’m looking for. Part of why I posted is that I’ve looked closely at many of the references to surā­meraya­majja­pamāda­ṭ­ṭhānā in the Nikāyas and found exactly the inconsistent usage and lack of specificity you’re describing. Thanks for the useful reflections on the difference between the lay precepts and the Vinaya. Do you know of other thinkers or commentators who interpret the precept the way you’re suggesting here: as prohibiting drunkenness rather than demanding complete abstinence?

And @Snowbird, that’s a helpful reminder — that the allowance for alcohol as medicine in the Vinaya is really as a vehicle for medicine, not as medicine itself.

What I’m still searching for is a discussion of the definition of medicine in a way that might be helpful for contemporary practitioners, lay or monastic, who find medicinal support in substances commonly considered intoxicants. It’s not about finding definitive guidance, for me at least, but is about expanding the conversation around substance use in a way that deconstructs the biases around substance use common in many white middle-class EBT-inspired saṅghas.

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Whether it is considered by others or yourself as Medicine or Drugs, I think it depends on what happens when you take a substance as to whether it is correct or not. I’m sure there are many medicines/drugs (together with their associated rituals) that are designed to make us better at operating out there in the world, doing more things, getting more ‘stuff’, etc., but are they conducive to dhamma?

There’s a nice teaching on the dhamma in brief given to Mahāpājapatī Gotamī (and Upāli) that acts as a sort of compass, giving us the right direction for us to be traveling in, wherever we happen to be on the path:

“Gotamī, you might know that certain things lead to passion, not dispassion; to being fettered, not to being unfettered; to accumulation, not dispersal; to more desires, not fewer; to lack of contentment, not contentment; to crowding, not seclusion; to laziness, not energy; to being burdensome, not being unburdensome. You should definitely bear in mind that these things are not the teaching, not the training, and not the Teacher’s instructions.

You might know that certain things lead to dispassion, not passion; to being unfettered, not to being fettered; to dispersal, not accumulation; to fewer desires, not more; to contentment, not lack of contentment; to seclusion, not crowding; to energy, not laziness; to being unburdensome, not being burdensome. You should definitely bear in mind that these things are the teaching, the training, and the Teacher’s instructions.”



Hi @stu. I love the Mahāpajāpatī instruction. That’s how I understand this issue myself.

An interesting example is the housewife Nakula’s mother, she is one of those white-robed disciples of the Buddha who fulfill their ethics. She has a beautiful conversation with her husband. And she shares with us that she has been celibate for 16 years already and she has fulfilled her Sila and she has internal serenity of heart.

To me it seems there is certainly space in the EBTs for householders who have some serious Sila, not just on Sabbath days.

“I am one of those white-robed disciples of the Buddha who fulfills their ethics.”

A beautiful Sutta: AN 6.16


Sorrowing and lamenting
doesn’t do even a little bit of good.
When they know that you’re sad,
your enemies are encouraged.
When an astute person doesn’t waver in the face of adversity,
as they’re able to assess what’s beneficial,
their enemies suffer,
seeing that their normal expression doesn’t change.
Chants_, recitations, fine sayings,
charity or traditions:
if by means of any such things you benefit,
then by all means keep doing them
But if you understand that ‘this good thing
can’t be had by me or by anyone else’,
you should accept it without sorrowing, thinking:
‘The karma is strong. What can I do now?’”

Buddha in agama

It’s not about the topic but I believe if anything benefit you, you should keep doing it, just don’t abuse, or attach, just as much as needed, when saw it helped

Stop if there is fear stopping will bring again suffering. You should be looking forward for healing and just letting it go. Dharma is about letting go.