WHY IT MATTERS: If protections for off-duty medical cannabis use are not codified for first responders, patients in safety-sensitive professions may continue to choose opioids over cannabis simply to avoid employment consequences, despite opioids carrying greater risks of dependence and cognitive impairment. CLINICAL OVERVIEW: Firefighters and other first responders face significant occupational hazards that contribute to chronic pain, PTSD, and sleep disorders, conditions for which medical cannabis has demonstrated meaningful therapeutic utility. Legislative efforts to protect off-duty medical cannabis use by these workers reflect a broader tension between workplace safety obligations and patients’ rights to access legal medical treatments.