1. Madeline H. Meiera,b,1, 2. Avshalom Caspia,b,c,d,e, 3. Antony Amblere,f,  4. HonaLee Harringtonb,c,d, 5. Renate Houtsb,c,d, 6. Richard S. E. Keefed, 7. Kay McDonaldf, 8. Aimee Wardf, 9. Richie Poultonf, and 10. Terrie E. Moffitta,b,c,d,e

1. aDuke Transdisciplinary Prevention Research Center, Center for Child and Family Policy,
2. bDepartment of Psychology and Neuroscience, and
3. cInstitute for Genome Sciences and Policy, Duke University, Durham, NC 27708;
4. dDepartment of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710;
5. eSocial, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London SE5 8AF, United Kingdom; and
6. fDunedin Multidisciplinary Health and Development Research Unit, Department of Preventive and Social Medicine, School of Medicine, University of Otago, Dunedin 9054, New Zealand
1. Edited by Michael I. Posner, University of Oregon, Eugene, OR, and approved July 30, 2012 (received for review April 23, 2012)

Abstract
Recent reports show that fewer adolescents believe that regular cannabis use is harmful to health. Concomitantly, adolescents are initiating cannabis use at younger ages, and more adolescents are using cannabis on a daily basis. The purpose of the present study was to test the association between persistent cannabis use and neuropsychological decline and determine whether decline is concentrated among adolescent-onset cannabis users. Participants were members of the Dunedin Study, a prospective study of a birth cohort of 1,037 individuals followed from birth (1972/1973) to age 38 y. Cannabis use was ascertained in interviews at ages 18, 21, 26, 32, and 38 y. Neuropsychological testing was conducted at age 13 y, before initiation of cannabis use, and again at age 38 y, after a pattern of persistent cannabis use had developed. Persistent cannabis use was associated with neuropsychological decline broadly across domains of functioning, even after controlling for years of education. Informants also reported noticing more cognitive problems for persistent cannabis users. Impairment was concentrated among adolescent-onset cannabis users, with more persistent use associated with greater decline. Further, cessation of cannabis use did not fully restore neuropsychological functioning among adolescent-onset cannabis users. Findings are suggestive of a neurotoxic effect of cannabis on the adolescent brain and highlight the importance of prevention and policy efforts targeting adolescents.