Today the Colorado Supreme Court dealt a significant blow to patients who use medical marijuana. The Court held that employers may freely fire medical marijuana patients for their private, off-duty, and legal use of marijuana.

At the time he was fired from Dish Network, Brandon Coats, a 34 year old quadriplegic, had been by all accounts a diligent employee who had never been disciplined. But after three years, Coats was subject to a random drug test and he tested positive for an undetermined amount of marijuana metabolites. Coats informed Dish that he used medical marijuana to treat debilitating and persistent muscle spasms and seizures, but they fired him for violating the company’s drug-free workplace rules anyway.

Patients in Colorado are now forced to choose between treating often debilitating symptoms with medical marijuana and earning a living. They may no longer be able to do both unless lawmakers pass robust reforms that protect patients.

At last count, 23 states and the District of Columbia have legalized marijuana for medical purposes. Several more states are considering bills that would allow patients access to medical marijuana. Yet despite this trend, very few of these laws provide any real safeguards for patients who use marijuana for medical purposes.

Indeed, across the country patients have lost their jobs because they use medical marijuana, even when their use of marijuana has no impact on their job performance. A Michigan man who had been Walmart’s Associate of the Year was fired after testing positive for marijuana, which he lawfully used under Michigan state law to treat an inoperable brain tumor. He sued Walmart, but a federal court rejected his lawsuit because the state law did not provide any employment protections for patients.

Employers argue they screen for marijuana to ensure a safe and productive work environment, or in some cases, to comply with federal regulations. But a law that excludes all users of marijuana without exception helps no one—neither the employer nor the employee.

Instead, it forces patients to either continue using marijuana and risk losing their jobs or it forces patients to refrain from using marijuana and substitute less effective methods, such as prescription narcotic pain relievers, which may be legal but can often lead to poor and unsafe performance. Neither situation is ideal.

Lawmakers must remedy the routine discrimination that is taking place against medical marijuana patients. They can do that by passing a law that would balance the interests of both patients and employers.

Such state reform might assert that a positive result for marijuana metabolites cannot automatically be grounds to fire an employee unless the patient used or was actually impaired by marijuana during the hours of employment. Employers might also be required to engage in an inquiry of whether there is an actual job-related reason that the patient-employee could not remain in the job. That’s the way it is in a few states, like Minnesota.

Federal legislation, such as the bi-partisan CARERS Act, can also protect patients in states that have reformed their marijuana laws. In the case of Colorado, the Supreme Court suggested that if there were an exception for the use of medical marijuana under federal law, Brandon Coats may have been able to keep his job because his off-duty would have been lawful.

Brandon Coats is not the first patient to get fired for using medical marijuana. But with legislative reform, hopefully he can be the last patient to be forced to make the impossible choice between keeping his job and receiving crucial medical treatment.