Dr. Lihi Bar-Lev Schleider, PH.D.

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Deprescribing Patterns After Medical Cannabis Initiation in Older Adults with Polypharmacy

Dr. Lihi Bar-Lev Schleider, Ph.D., Research Department, Tikun-Olam

Introduction:

Medical cannabis use among older adults has increased substantially, particularly in medically complex patients with chronic symptoms and high medication burden. Polypharmacy in this population is associated with adverse clinical outcomes, yet real-world data describing medication utilization during medical cannabis treatment remain limited. This study evaluated changes in medication burden, pain intensity, quality of life (QOL), and safety among older adults with polypharmacy initiating medical cannabis.

Materials and Methods:
We conducted a prospective observational study with six-month follow-up including patients aged ≥65 years with polypharmacy (≥5 medications) who initiated medical cannabis following individualized clinical assessment and product matching in a specialized clinic. Patients received standardized, quality-controlled medical cannabis products. Medication use, pain intensity (VAS), QOL, and adverse effects were assessed at baseline and follow-up. Medication dosages were recorded at both time points, and a predefined algorithm categorized changes per patient as increased, decreased, or unchanged.

Results:
A total of 724 patients completed follow-up. Baseline medication burden was high (median 8 medications, IQR 6–10). Over six months, 48.2% (95% CI 0.46–0.50) reduced medication count and/or dosages. Median medication count decreased from 8 (IQR 6–10) to 7 (IQR 5–9) (p<0.001). Pain intensity declined from median VAS 9 (8–10) to 4 (2–6) (p<0.001). QOL improved, with 51.0% reporting good or very good QOL at follow-up compared with 8.0% at baseline (p<0.001). Adverse effects were reported by 32.4% of patients and were predominantly mild, including dizziness (10.9%), dry mouth (5.4%), and sleepiness (2.9%). Baseline clinical characteristics did not differ between patients with and without medication reduction.

Conclusions:
In this prospective observational cohort of older adults with polypharmacy, initiation of medical cannabis was associated with reduced medication burden and significant improvements in patient-reported pain and quality of life. Medication reductions were observed across multiple drug classes, most frequently involving opioids, other analgesics, antiepileptics, sedative-hypnotics, and antidepressants. These findings support the need for controlled studies to further evaluate the role of medical cannabis in medication management among medically complex older patients.

Dr. Lihi 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.

Her work has been published in leading peer-reviewed journals and has received more than 2,300 citations (h-index 16).

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.

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