ficulty of fine-tuning the dosage of THC in pill form. Moreover, when taken orally, THC tends to be slow to act and to clear from the body.

For these reasons some AIDS patients—and also some cancer patients who have used Marinol to combat wasting and chemotherapy-induced nausea—report that they prefer smoking marijuana to swallowing THC. Smoking, they say, allows them to inhale just enough of the drug to relieve their symptoms. They also cite “the munchies”—well known among marijuana users and documented in laboratory studies of normal, healthy adults who gained both appetite and weight while using marijuana.5 Unfortunately, there have been no controlled studies to date on the benefits of marijuana smoking on appetite, weight gain, or body composition among people with HIV. In May 2000, Donald Abrams, a medical researcher at the University of California at San Francisco, completed the first controlled study of the short-term safety of smoked marijuana in HIV patients. The results showed that patients who smoked marijuana for 21 days did not show any increase in the HIV virus during the study period.

Clearly, there is a need for medications that can prevent or restore the loss of lean tissues that occurs during AIDS wasting. Preliminary studies of anabolic compounds such as testosterone or growth hormone appear encouraging. Researchers are also investigating whether inhibitors of cytokines—chemical messengers believed to stimulate the inflammatory process that provokes cachexia—could be used to increase lean body mass. While marijuana derivatives do not appear to reverse cachexia, they could potentially form part of a combination treatment for wasting. For example, cannabinoid drugs might be used to boost patients' food consumption while they undergo physical therapy or take medications designed to increase the proportion of lean tissues in their bodies.

PAIN

In addition to appetite stimulation, marijuana-based medicines may prove helpful in treating a variety of painful symptoms associated with AIDS. In particular, many AIDS patients suffer



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