Evaluating substance use outcomes of recreational cannabis legalization using a unique co-twin control design

Background: As more states pass recreational cannabis legalization (RCL), we must understand how RCL affects substance use. Objectives: The current study aims to examine the effect of RCL on lifetime and past-year use of cannabis, alcohol, tobacco, and other drugs, frequency of cannabis, alcohol, and tobacco use, co-use of cannabis with alcohol and tobacco, and consequences from cannabis and alcohol use. Methods: We used a unique, co-twin control design of twin pairs who were discordant for living in a state with RCL between 2018 and 2021. The sample consisted of 3,830 adult twins (41% male), including 232 twin pairs discordant for RCL. Problems from alcohol and cannabis use were assessed via the Brief Marijuana Consequences Questionnaire and the Brief Young Adult Alcohol Consequences Questionnaire. Results: Results indicated that the twin living in an RCL state was more likely to endorse past-year cannabis use (OR = 1.56, p =.009), greater number of cannabis use days in the past 6 months (β = 0.47, p =.019), but not more negative consequences from cannabis use (β = 0.21, p =.456) compared to their co-twin in a non-RCL state. There were no differences within-twin pairs in frequency of alcohol use (β=-0.05, p =.601), but the RCL twin reported fewer negative consequences from alcohol use (β=-0.29, p =.016) compared to their co-twin in a non-RCL state. We did not observe any other differences within-twin pairs on other outcomes. Conclusion: These results suggest that living in an RCL state is associated with greater cannabis frequency but not more negative consequences from cannabis use than living in a non-RCL state.