Marijuana (Cannabis sativa) is best-known as a recreational drug that promotes feelings of well-being and relaxation. The production and sale of marijuana is illegal, and the drug is not available from herbalists or other complementary therapy practitioners. Nonetheless, many people with HIV find it useful in preventing nausea and stimulating appetite. Some use it to control pain. Cesamet and Marinol, two drugs that contain components of marijuana, are approved in Canada to suppress nausea and stimulate appetite. However, many PHAs who have tried these drugs prefer to smoke the herb itself. Not only have they found the herb more effective but they believe that smoking marijuana makes it easier to control the dose. Both Cesamet and Marinol have been reported to cause brief, unpleasant periods of disorientation.

The Canadian federal government has set up a system to grant the legal right to grow, possess and use marijuana for medical reasons. These "Marihuana Medical Access Regulations" went into effect July 2001. People living with HIV who want to use marijuana medicinally need to have their physician (usually a specialist) fill out the required forms. The Spring 2002 issue of CATIE's magazine the Positive Side has more information about the use of marijuana in HIV infection, including how to access this restricted herb. The Positive Side is available at www.catie.ca/e/pubs/index.html or by calling 1-800-263-1638.

Marijuana itself has few side effects other than the usually pleasant mood and perception alterations that may accompany its use. It may cause tachycardia (rapid beating of the heart), which can usually be controlled by decreasing the dose. Smoking marijuana is associated with the same long-term side effects as smoking cigarettes, including emphysema, high blood pressure and lung cancer. Alternatives to smoking include using the ground herb in baked goods (brownies, for example) and brewing it as a tea. Short-term studies indicate that marijuana can be safely used with some protease inhibitors.