State legislators in New Mexico recently dropped a bill that would have allowed workers’ compensation insurers from having to pay for their client’s medical marijuana treatment. The bill could have set a dangerous precedent for patients across the country, especially ones who might choose opioid treatment over cannabis simply because their insurance will pay for morphine, but not for skunk.

Greg Vialpando, a disabled former automobile body worker who uses marijuana to treat chronic pain, appeared before New Mexico lawmakers to fight for the right to have cannabis treated like any other medicine. He said that marijuana freed him from the stupor caused by using opioids and other prescription narcotics. “I would recommend that people use medical marijuana over opioids any day,” Vialpando told The New York Times in a recent interview.

Even though patients like Vialpando won a battle in New Mexico, the war for insurance coverage of medical cannabis is far from over. There are two major problems that still block MMJ patients from insurance coverage: the federal ban on marijuana and a workplace’s right to be drug-free.

Beside the ruling in New Mexico, lower courts in Michigan, Maine, Massachusetts and Connecticut have given similar dictums to workplace insurers. But the number of marijuana patients actually getting their MMJ bill picked by workers’ comp is still pretty small. It’s not just the usual sleazy insurance company tactics either. Many insurance companies don’t want to directly pay for medical marijuana, as they would still be purchasing a Schedule I controlled substance, according to federal regulations.

Firms are forced to find workaround strategies such as reimbursing patients for their marijuana costs instead of paying a dispensary directly. “The legality of this has not been tested in court,” general counsel of the California Workers’ Compensation Institute Ellen Sims Langille told NYT.

The other hazy question for worker’s coverage of MMJ is that many employers can (and do) legally forbid their employees from using marijuana.  “We are entering this conflict between a social policy decision and a workplace that is highly regulated,” according to Alex Swedlow, the chief executive the research group, California Workers’ Compensation Institute.

All states permit employers to establish a drug-free workplace. Though some states protect medical marijuana patients from receiving adverse treatment because they test positive for cannabis, many workers are not protected by these provisions and find themselves in a limbo, and may have to choose between their job and their doctor-recommended treatment.

Photo via Flickr user David Gach