Deprescribing: Patterns After Medical Cannabis Initiation in Older Adults with Polypharmacy
June 11, 2026
At the June CMCR Investigators’ Meeting, Lihi Bar-Lev Schleider, PhD, Clinical Cannabis Researcher and Medical Director, Tikun Olam USA, presented findings from a prospective real-world cohort study of medical cannabis treatment among older adults with polypharmacy. Conducted through a specialized medical cannabis clinic in Israel operated by Tikun Olam, the study focused on six-month outcomes among patients aged 65 years or older who were using at least five medications per day.
Dr. Bar-Lev Schleider framed polypharmacy as a major challenge in geriatric care, associated with adverse drug events, drug interactions, falls, cognitive and functional decline, hospitalization, and reduced quality of life. Deprescribing can be difficult when older adults experience multiple symptoms simultaneously or become caught in prescribing cascades. The study therefore evaluated whether medical cannabis treatment was associated with changes in medication use, pain, symptom burden, quality of life, and safety.
Of 3,123 patients aged 65 years or older who received a medical cannabis license through the clinic over three years, 1,765 met inclusion criteria for age and polypharmacy. After six months, 724 patients remained in active treatment and completed follow-up. The cohort had a mean age of approximately 75 years, a median of eight medications per day, and an average of 8.3 symptoms. The most common treatment indications were chronic pain, cancer-related symptoms, and Parkinson’s disease.
After six months, 48.2% of patients reduced either the number or dose of medications used. Across the full cohort, the median number of daily medications decreased from eight to seven; among treatment successes, the median decreased from eight to six. The largest reduction was observed for opioids: 35.4% of baseline opioid users stopped opioids entirely, and 11.3% reduced their dose.
Clinical outcomes also improved. Median pain scores decreased from 9 to 4 on a 0-to-10 scale, while severe pain declined from 75% to 9%. Overall, 94.3% reported improvement in their general medical condition, and quality-of-life ratings of good or very good increased from 8% to 51%.
Side effects were reported by 32.4% of patients, most commonly dizziness, dry mouth, sleepiness, psychoactive effects, nausea, and increased appetite. Dr. Bar-Lev Schleider emphasized that the findings should be interpreted as associations rather than causal effects, because the study was observational, lacked a control group, and included only patients who remained in treatment and completed follow-up. She concluded that medical cannabis may be a useful additional tool for clinicians managing older adults with multimorbidity and polypharmacy, while underscoring the need for controlled studies.
Lihi Bar-Lev Schleider, PhD
Dr. Bar-Lev Schleider is a clinical researcher with over 18 years of experience in randomized placebo-controlled trials and real-world evidence studies in medical cannabis. She earned her PhD in Epidemiology at Ben-Gurion University of the Negev under the mentorship of Prof. Raphael Mechoulam and Prof. Victor Novack. Dr. Bar-Lev Schleider has led clinical research across multiple indications, including cancer, dementia, cerebral palsy, Crohn’s disease, ulcerative colitis, autism, fibromyalgia, and other complex chronic conditions. She established and directed Israel’s largest real-world medical cannabis data registry, evaluating both short- and long-term treatment outcomes and contributing to the scientific evidence that supported the expansion of medical cannabis indications in Israel. She currently serves as Medical Director at Tikun Olam USA, where she contributes clinical and research expertise to the development of evidence-based medical cannabis programs.