MASSACHUSETTS INSURERS cannot be required to cover medical marijuana expenses, the Supreme Judicial Court ruled Tuesday.

The SJC upheld the ruling of a Department of Industrial Accidents’ board, which found that a workers’ compensation policy does not have to cover medical marijuana expenses for a man injured on the job. The court acknowledged the complex morass of policy created by the conflict between state and federal law — many states, including Massachusetts, have legalized medical marijuana yet the drug remains federally illegal.

“We recognize that the current legal landscape of medical marijuana law may, at best, be described as a hazy thicket,” wrote Justice Scott Kafker in the 32-page unanimous opinion.

Daniel Wright, who worked as a cable installer and then an electrical apprentice, suffered two work-related injuries in 2010 and 2012. He said medical marijuana helped alleviate his chronic pain from the injuries and let him eliminate the use of opioids.  He spent over $24,000 on medical marijuana, generally spending around $100 every one to two weeks. He applied for reimbursement from his workers’ compensation policy, but was denied on the grounds that medical marijuana is federally illegal.

The SJC agreed that Wright should not be compensated. The court’s decision focused on a provision in the state’s medical marijuana law which states that no health insurer or government agency be required to reimburse someone for medical marijuana expenses. The language was put in place to avoid conflicts with federal law since many insurers are bound by federal rules.

“It is one thing for a state statute to authorize those who want to use medical marijuana, or provide a patient with a written certification for medical marijuana, to do so and assume the potential risk of federal prosecution; it is quite another for it to require unwilling third parties to pay for such use and risk such prosecution,” Kafker wrote. “The drafters of the medical marijuana law recognized and respected this distinction.”

Kafker noted that allowing medical marijuana at a state level despite federal prohibition “remains somewhat of a high wire act,” and the state law is written in a way to minimize clashes with federal law by not requiring insurers to cover it – a protection that the SJC ruled extends to both health insurers and workers’ compensation insurers. “If insurers were required to make such payments, the size and scope of the legalization of medical marijuana would be substantially expanded, raising concerns about federal enforcement and preemption,” Kafker wrote. He said insurers would have legitimate worries about federal criminal prosecution.

Nichole Snow, executive director of the Massachusetts Patient Advocacy Alliance, which supports requiring health insurers to cover medical marijuana, called the decision deeply unfortunate. “It’s a medical treatment, and as a patient advocacy organization, we’re trying to reduce stigma and barriers as much as we can for patients that choose to use medical marijuana,” Snow said.