Medical Cannabis for Older Adults in Israel

Israel's medical cannabis programme skews older than most people assume, and it has produced something rarer than enthusiasm: a run of prospective studies that followed elderly patients through their first six months of treatment and wrote down what happened, including the parts that did not work.

That evidence is worth reading before starting, because the picture it paints is neither the miracle nor the menace. It is a modest, measurable benefit in pain and function, side effects in roughly a third of patients, and a meaningful number of people who stop.

This guide is general information, not medical advice. Cannabis interacts with other medicines and carries particular risks in older adults. Nothing here is a recommendation to start, stop or change any treatment; those decisions belong with a treating physician.

How many Israeli patients are older

There is no official "65+" figure, because the Health Ministry does not publish one. The most detailed age breakdown available came out under a freedom-of-information petition, covering active licence holders in 2018–2020 (Ministry of Health data, released via the Movement for Freedom of Information).

In 2020, of 91,889 active licence holders, the ministry counted 18,087 aged 60–69, 12,705 aged 70–79, 6,195 aged 80–89 and 1,473 aged 90 or over. By our own arithmetic on those counts, patients aged 60 and over made up roughly 42% of the programme, and those aged 70 and over roughly 22% — that percentage is our calculation, not a ministry figure.

The direction of travel is also documented: a review of licensure trends from 2013 to 2018 found a falling share of patients aged 41–65 and a rising share aged over 66, as summarised in the most recent overview of the programme (Aviram, Journal of Cannabis Research, 2025). For the overall licence trend, see Israel's medical cannabis patient numbers.

The Israeli geriatric protocol: start low, stay low

The most-cited Israeli work on this population comes from a specialised geriatric cannabis clinic, studied by researchers from the Cannabis Clinical Research Institute at Soroka University Medical Center and Ben-Gurion University. Their first paper followed 184 consecutive patients over 65 who began treatment between April 2017 and October 2018. The mean age was 81.2 years, the median 82, 63.6% were women, and 83.2% were 75 or older (Abuhasira et al., Journal of Clinical Medicine, 2019).

Their indications were overwhelmingly physical rather than psychiatric: non-specific chronic pain including neuropathic pain in 57.1%, Parkinson's disease in 6.5%, orthopedic pain in 5.4%, oncology treatment in 3.8%, and dementia and arthritis in 2.7% each.

The protocol they describe is deliberately conservative, and it is the most practically useful part of the paper. Treatment starts at "5 mg of THC and CBD a day divided into three doses (approximately 1.7 mg in a single dose) with an upward titration of 5 mg every three days," with common therapeutic doses of "5–30 mg of THC and CBD per day." The preferred route is sublingual oil; the authors write that "smoking cannabis should be deferred" and that they "do not recommend using oral preparations in older adults." Their summary of the whole approach: "Start low, go slow, and stay as low as possible."

At six months, 58.1% were still using cannabis and 8.1% had discontinued, with the remainder lost to follow-up or not yet at the six-month mark. Of 112 patients who gave a global assessment, 84.8% reported some degree of improvement in their general condition. Among those still on treatment, 33.6% reported adverse events — most commonly dizziness (12.1%), sleepiness and fatigue (11.2%), dry mouth (5.6%) and a psychoactive sensation (5.6%).

Two caveats belong with those numbers. The study was uncontrolled, so "improvement" is self-reported against no comparator. And the research was "partially funded by NiaMedic Healthcare and Research Services," the private company running the clinic, with two authors employed there.

Does it cost older patients their independence?

The obvious worry with cannabinoids in the elderly is not pain relief but function: sedation, unsteadiness, confusion. A later study from the same clinic tested it directly, following 119 patients over 65 who started treatment between 2018 and 2020, with no exclusion criteria (Abuhasira, Schwartz & Novack, Biomedicines, 2023).

After six months:

• Basic activities of daily living were unchanged — Katz ADL 4.4 to 4.5 (p = 0.268).
• Instrumental activities improved — Lawton IADL 4.1 to 4.7 (p = 0.023), a change the authors call clinically significant against a minimally important difference of about half a point.
• Pain fell substantially — visual analogue scale 8.8 to 5.5 (p < 0.001).
• Mood improved — Geriatric Depression Scale 6.4 to 5.0 (p = 0.015).
• Opioid use fell — 23.5% stopped opioid analgesics, and among those on opioids at baseline the mean morphine milligram equivalent per day fell from 49.0 to 27.9 (p = 0.008).

The paper's own two conclusions are worth quoting side by side, because they are pitched differently. The abstract: "medical cannabis in older adults has a number of serious adverse events, but was not associated with a decrease in functional status." The concluding section: "Medical cannabis in older adults can improve functional status and mood."

Both are defensible, and the adverse events are real. Some 36.1% reported an adverse event, including dizziness (11.8%), dry mouth, a psychoactive sensation (7.6% each), fatigue, nausea and instability (4.2%); 7.6% called their side effects severe, 1.7% needed medical care, and two patients (1.7%) had died by the end of follow-up. Note also that while the safety figures rest on all 119 patients, the outcome measures rest on 81 respondents.

One finding deserves particular attention: patients whose instrumental function improved were markedly younger than those whose did not — mean age 77.8 versus 85.2 (p = 0.001). Benefit is not evenly distributed across "older adults" as a single category.

Why patients stopped

In that same 2023 cohort, a quarter of patients (25.2%) had stopped by six months. The reasons are instructive: 36.7% because the treatment was ineffective, 23.3% because of adverse effects, and 23.3% because of bureaucratic difficulty renewing their licence. Five patients reported withdrawal symptoms including abdominal pain, restlessness and low mood.

That third category is the avoidable one. Renewal is a scheduled, predictable obstacle, and it should not be what ends a working treatment — see medical cannabis licence renewal in Israel and, for the out-of-pocket picture, what medical cannabis costs.

Blood pressure, and the drug-interaction question

A separate Israeli study monitored 26 patients aged 60 or over with hypertension using 24-hour ambulatory blood-pressure measurement before treatment and three months after. Mean 24-hour systolic and diastolic pressures fell by 5.0 and 4.5 mmHg respectively (p < 0.001 for both), with the nadir "achieved at 3 hours post-administration" (Abuhasira et al., European Journal of Internal Medicine, 2021).

This is a small, single-arm study and the effect is modest — but it is the kind of effect that matters most in exactly this population, where many patients are already on antihypertensives and where a transient drop three hours after a dose is a plausible fall risk. It is a reason to tell the prescribing physician about every other medicine, not a reason to expect cannabis to treat hypertension.

Dementia: a narrow, CBD-only indication

Israel added behavioural disturbances in dementia as an indication in January 2022. It is tightly drawn: the recommendation must come from a specialist in geriatrics, psychiatry, neurology or palliative medicine, the patient must be under continuous medical supervision with documented repeated behavioural problems, and — importantly — treatment is restricted to CBD-rich extract products rather than flower.

Uptake has been small, peaking at 337 licence approvals, about 0.2% of the programme (Aviram, 2025). The strongest supporting evidence is an Israeli randomised trial at Laniado Hospital: 60 patients with major neurocognitive disorder and behavioural disturbances, randomised 2:1 to a broad-spectrum oil (30% CBD, 1% THC) or placebo for 16 weeks. A meaningful reduction in agitation scores was reached by 60.0% on treatment versus 30.0% on placebo (p = 0.03) (Hermush et al., Frontiers in Medicine, 2022).

Read it with its limits: adverse events occurred in about 90% of both arms, all eight discontinuations and both deaths were in the treatment group, and the study was funded by the manufacturer of the oil tested. The authors themselves write that "one trial is not enough to make conclusions on the safety and efficacy of broad-spectrum CBD."

What this means in practice

• Dose expectations should be small. The Israeli geriatric protocol starts at 5 mg a day, split three ways, and commonly runs to about 30 mg a day.
• Route matters. Sublingual oil is the standard here; smoking is deferred in this population, and for dementia only CBD-rich extracts are permitted.
• Polypharmacy is the main risk surface, not the cannabis alone — blood-pressure and sedation effects land on top of existing prescriptions.
• Function is not automatically lost, but benefit skews younger. The patients who gained function were, on average, seven years younger than those who did not.
• Plan the renewal. Nearly a quarter of those who stopped did so over paperwork.

For the wider access picture see our Patient Access hub; for chronic pain, the leading indication in this age group, see medical cannabis for chronic pain in Israel; and for the institutions producing this evidence, Israel's cannabis research institutions.