Aims: This study tested whether adolescents who used cannabis or met criteria for cannabis dependence showed neuropsychological impairment prior to cannabis initiation and neuropsychological decline from before to after cannabis initiation. Design: A longitudinal co-twin control study. Setting and Participants: Participants were 1,989 twins from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative birth cohort of twins born in England and Wales from 1994-1995. Measurements: Frequency of cannabis use and cannabis dependence were assessed at age 18. Intelligence quotient (IQ) was obtained at ages 5, 12, and 18. Executive functions were assessed at age 18. Findings: Compared with adolescents who did not...