Vincent Hager v. M & K Construction (084045) (Statewide) ( 2021 )


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  •                                        SYLLABUS
    This syllabus is not part of the Court’s opinion. It has been prepared by the Office of the
    Clerk for the convenience of the reader. It has been neither reviewed nor approved by the
    Court. In the interest of brevity, portions of an opinion may not have been summarized.
    Vincent Hager v. M&K Construction (A-64-19) (084045)
    Argued December 1, 2020 -- Decided April 13, 2021
    SOLOMON, J., writing for the Court.
    In this appeal, the Court considers the challenges brought by defendant M&K
    Construction (M&K) with regard to a workers’ compensation court’s order (the Order)
    that M&K reimburse plaintiff Vincent Hager for the ongoing costs of the medical
    marijuana he was prescribed after sustaining a work-related injury while employed by
    M&K. Specifically, M&K contends that New Jersey’s Jake Honig Compassionate Use
    Medical Cannabis Act (Compassionate Use Act or the Act) is preempted as applied to the
    Order by the federal Controlled Substances Act (CSA). Compliance with the Order,
    M&K claims, would subject it to potential federal criminal liability for aiding-and-
    abetting or conspiracy. M&K also asserts that medical marijuana is not reimbursable as
    reasonable or necessary treatment under the New Jersey Workers’ Compensation Act
    (WCA). Finally, M&K argues that it fits within an exception to the Compassionate Use
    Act and is therefore not required to reimburse Hager for his marijuana costs.
    Hager suffered a back injury while working for M&K in 2001. He underwent
    surgery, but his pain persisted and he continued to take prescribed opioid medication. In
    April 2016, Hager began treating with a hospice and palliative care physician, who
    enrolled Hager in New Jersey’s medical marijuana program both as an alternative pain
    treatment and as a means to wean him off of opioids. Hager’s marijuana prescription cost
    him more than six hundred dollars each month.
    At a worker’s compensation trial, Hager testified personally, and both he and
    M&K presented testimony by medical experts. Identifying medical marijuana and
    opioids as the only two choices for pain management, the court concluded that
    “marijuana is the clearly indicated option” and ordered M&K to reimburse the costs of
    Hager’s medical marijuana and reasonably related expenses. The compensation court
    rejected M&K’s claim that, like a private health insurer or government medical benefit
    program, M&K could not be required to reimburse the cost of medical marijuana.
    The Appellate Division affirmed, 
    462 N.J. Super. 146
    , 153 (App. Div. 2020), and
    the Court granted M&K’s petition for certification, 
    241 N.J. 484
     (2020).
    1
    HELD: M&K does not fit within the Compassionate Use Act’s limited reimbursement
    exception, and Hager presented sufficient credible evidence to the compensation court to
    establish that the prescribed medical marijuana represents, as to him, reasonable and
    necessary treatment under the WCA. Finally, the Court interprets Congress’s
    appropriations actions of recent years as suspending application of the CSA to conduct
    that complies with the Compassionate Use Act. As applied to the Order, the Court thus
    finds that the Act is not preempted and that M&K does not face a credible threat of
    federal criminal aiding-and-abetting or conspiracy liability. M&K is ordered to
    reimburse costs for, and reasonably related to, Hager’s prescribed medical marijuana.
    1. The Court first considers whether M&K is exempt from reimbursing Hager for his
    medical marijuana under N.J.S.A. 34:6I-14. The Compassionate Use Act, N.J.S.A.
    24:6I-1 to -30, was enacted by the New Jersey Legislature in 2010 in recognition of the
    beneficial uses of marijuana and to protect authorized individuals from criminal and civil
    penalties. Of relevance to the present matter, the Act provides that reimbursement for
    medical marijuana costs is not required of “a government medical assistance program or
    private health insurer.” N.J.S.A. 24:6I-14 (emphasis added). (pp. 13-15)
    2. Based that plain language, the Court agrees with the compensation court’s
    determination, affirmed by the Appellate Division, that N.J.S.A. 24:6I-14 does not apply
    to M&K. The Court reads “or” as limiting the applicability of the exception to only the
    two kinds of entities named, in accordance with general principles of statutory
    interpretation and the Act’s recognition of the potential health benefits of medical
    marijuana. See N.J.S.A. 24:6I-2(e). That reading, further, is supported by the definition
    of “Health insurance” in the Life and Health Insurance Code, which unambiguously
    states “[h]ealth insurance does not include workmen’s compensation coverages.”
    N.J.S.A. 17B:17-4. In the Court’s view, if the Legislature sought to depart from that
    general definition and treat workers’ compensation and private health coverage in the
    same manner under the Compassionate Use Act, it could have expressly included
    workers’ compensation insurance in its exhaustive list or broadened the exception more
    generally, as other states have explicitly done. The Court concludes that the Legislature
    clearly did not intend for workers’ compensation insurers to be treated as private health
    insurers or government medical assistance programs under the Compassionate Use Act.
    M&K is therefore not exempt from its reimbursement obligation. (pp. 15-18)
    3. The Court next considers M&K’s argument that medical marijuana is not a
    “reasonable and necessary treatment” for which the WCA provides coverage. The Court
    reviews the legislative history of the WCA, which requires employers to provide “such
    medical, surgical and other treatment . . . as shall be necessary to cure and relieve the
    worker of the effects of the injury” incurred in the course of employment, and specifies
    that all fees for the “treatment shall be reasonable.” N.J.S.A. 34:15-15. Under
    interpretive case law, it must be shown that the chosen treatment is “reasonable” and
    “necessary” to cure or relieve the injury of the worker. A mere showing that the injured
    2
    worker would benefit from the treatment is not enough. Nevertheless, palliative care may
    be properly authorized under the WCA, and workers who are permanently disabled and
    beyond hope of being cured are still entitled to continued treatment and services.
    Competent medical testimony that a particular treatment or service will reduce symptoms
    or restore function is sufficient to satisfy the requirement of reasonable and necessary
    care. (pp. 18-20)
    4. Like the compensation court and the Appellate Division, the Court concludes that
    medical marijuana may be found, subject to competent medical testimony, to constitute
    reasonable and necessary care under New Jersey’s workers’ compensation scheme. The
    Court reviews Squeo v. Comfort Control Corp., 
    99 N.J. 588
     (1985), which instructs its
    analysis here. In this appeal, the doctors who testified on behalf of Hager convinced the
    compensation court that Hager remains in chronic pain and that ongoing treatment is
    necessary. Identifying medical marijuana and opioids as the two treatment options
    available, the court concluded, after thoughtful consideration of the medical testimony
    discussing the risks and benefits of each, that marijuana was “the clearly indicated
    option.” Reimbursement payments for the cost of Hager’s prescribed medical marijuana
    -- the treatment ordered here -- may not yet be common, but they are certainly less unique
    than the construction of a self-contained apartment, which the Court found appropriate in
    Squeo. Indeed, marijuana’s ability to relieve pain has been expressly recognized by the
    Legislature in the Compassionate Use Act. N.J.S.A. 24:6I-2(a), -3. Thus, competent
    evidence relating to medical marijuana’s ability to restore some of a worker’s function or,
    as in Hager’s case, relieve symptoms such as chronic pain and discomfort, is sufficient to
    find such a course of treatment appropriate. As in Squeo, the Court recognizes the
    potential harm that may be inflicted on Hager by the alternative available treatment; here,
    that would mean opioid treatment and a “likely path . . . [of] worsening addiction and
    ultimately death.” Sufficient credible evidence in the compensation court record --
    medical records and hearing testimony -- supported the Order. (pp. 21-23)
    5. The Court next considers whether the federal CSA extinguishes M&K’s obligations
    under state law. New Jersey law diverges from federal law not just as to medical
    marijuana but as to its recreational use as well, given New Jersey’s recent legalization of
    recreational marijuana. Notwithstanding New Jersey’s legalization of the medical and
    recreational use of marijuana, the CSA must be considered. The principles of federal
    preemption are rooted in the Supremacy Clause of the United States Constitution, U.S.
    Const. art. VI, cl. 2, which unambiguously provides that if there is any conflict between
    federal and state law, federal law shall prevail. Because the CSA explicitly leaves room
    for state law to operate, see 
    21 U.S.C. § 903
    , the Court focuses on conflict preemption,
    which occurs in two scenarios: where it is impossible for a private party to comply with
    both state and federal requirements, and when state law stands as an obstacle to the
    accomplishment and execution of the full purposes and objectives of Congress. The
    Court explains that preemption is not to be lightly presumed and that deciphering
    congressional intent is central to preemption analysis. (pp. 24-29)
    3
    6. Enacted by Congress in 1970, the CSA replaced a network of drug laws with a
    comprehensive regime, separating controlled substances into five schedules based on
    their accepted medical uses, risk of abuse, and physical and psychological effects.
    Marijuana was placed in the strictest schedule -- Schedule I -- at the time of the CSA’s
    enactment. Substances on Schedule I must be found to have a high potential for abuse,
    no currently accepted use for medical treatment, and a lack of accepted safety measures
    for use under medical supervision. 
    21 U.S.C. § 812
    (b)(1). Marijuana remains a Schedule
    I drug today, despite repeated efforts to petition for its rescheduling. Except as otherwise
    authorized, the CSA makes it unlawful to knowingly or intentionally “possess with intent
    to manufacture, distribute, or dispense, a controlled substance.” 
    Id.
     § 841(a)(1). The
    CSA also makes unlawful, subject to exceptions, the knowing or intentional possession of
    a controlled substance “unless such substance was obtained directly, or pursuant to a
    valid prescription or order, from a practitioner, while acting in the course of his
    professional practice.” Id. § 844(a). (pp. 30-31)
    7. The “valid prescription” language contained in § 844(a) cannot, however, apply to
    marijuana because the CSA prevents marijuana from being validly prescribed. On the
    enforcement front, guidance from senior personnel in the Department of Justice (DOJ) to
    the offices of the United States Attorneys issued over the past decade or so has, at times,
    deprioritized -- but not prohibited -- federal prosecution of marijuana activities that are
    legal under state law. More importantly, Congress has also deprioritized prosecution for
    possession of medical marijuana while leaving the CSA otherwise unchanged. In the
    relevant rider to the most recent federal Appropriations Act, Congress prohibited the DOJ
    from using allocated funds to prevent states, including New Jersey, from implementing
    their medical marijuana laws. Similar language has been included in appropriations
    riders dating back to the 2015 federal budget. (pp. 32-35)
    8. The tension between Congress’s appropriations riders and the CSA’s classification
    and criminalization of marijuana is manifest. Mindful that preemption analysis turns on
    legislative intent, the Court reviews case law examining whether and under what
    circumstances appropriations acts -- reflecting a shift in intent with respect to earlier
    legislation -- are deemed to impliedly suspend or supplant the earlier law. “[A]lthough
    repeals by implication are especially disfavored in the appropriations context, Congress
    nonetheless may amend substantive law in an appropriations statute, as long as it does so
    clearly.” Robertson v. Seattle Audubon Soc’y, 
    503 U.S. 429
    , 440 (1992). The Court
    observes that the federal decisions it has reviewed mirror the Court’s own reading of
    appropriations acts as signifiers of legislative intent to suspend earlier statutory
    enactments in City of Camden v. Byrne, 
    82 N.J. 133
     (1980). The Court noted in Byrne,
    as did the Ninth Circuit in United States v. McIntosh, 
    833 F.3d 1163
     (9th Cir. 2016), the
    limited applicability of appropriations laws -- confined to a particular fiscal year -- and
    concluded that their effect on the previously enacted statutes was best expressed as
    implied suspension as opposed to implied repeal. (pp. 36-41)
    4
    9. Here, the CSA expressly contemplates a role for state law absent a “positive conflict”
    with the CSA. See 
    21 U.S.C. § 903
    ; see also Gonzales v. Oregon, 
    546 U.S. 243
    , 251
    (2006). The Compassionate Use Act seeks to operate in the space afforded to it by
    federal law and federal priorities. Congress has, for seven consecutive fiscal years,
    prohibited the DOJ from using funds to interfere with state medical marijuana laws
    through appropriations riders. Congress is empowered to amend the CSA via an
    appropriations action provided “it does so clearly,” see Robertson, 
    503 U.S. at 440
    , and
    the most recent appropriations rider, in the Court’s view, “clearly is intended as a
    substitute” to the CSA as applied to the Compassionate Use Act, see Miccosukee Tribe of
    Indians of Fla. v. U.S. Army Corps of Eng’rs, 
    619 F.3d 1289
    , 1299 (11th Cir. 2010).
    Therefore, the Court finds that Congress has spoken through the most recent
    appropriations rider and gives it the final say. (pp. 41-44)
    10. The Court concludes that the CSA, as applied to the Compassionate Use Act and the
    Order at issue, is effectively suspended by the most recent appropriations rider for at least
    the duration of the federal fiscal year. Because DOJ enforcement of the CSA may not, by
    congressional action, interfere with activities compliant with the Compassionate Use Act,
    the Court finds that there is no “positive conflict” and that the CSA and the Act may
    coexist as applied to the Order. See 
    21 U.S.C. § 903
    . Qualified patients may continue to
    possess and use medical marijuana, and related compensation orders may be entered
    while federal authorities continue to enforce the CSA to the extent Congress permits.
    The federal and state acts can thus consistently stand together, and it is possible for M&K
    to comply with both. The Compassionate Use Act does not currently present an obstacle
    to Congress’s objectives as articulated in the recent appropriations riders, and so the CSA
    does not preempt the Compassionate Use Act as applied to the Order. The Court
    underscores the “temporal nature” of the issue and its dependence on the future acts of
    Congress. See McIntosh, 833 F.3d at 1179. (pp. 44-47)
    11. The Court is unpersuaded by M&K’s contention that its compliance with the Order
    would subject it to aiding-and-abetting and conspiracy liability under federal law on the
    theory that it would be assisting in Hager’s possession of marijuana, contrary to the CSA.
    M&K’s payments would not satisfy the specific intent requirement for aiding-and-
    abetting liability when the facts so clearly indicate that it will be reimbursing Hager
    against its will and at the behest of the Court. Likewise, to the extent that the Order
    requiring reimbursement payments creates a conspiracy between Hager and M&K,
    M&K’s membership cannot be said to be intentional. Rather, its participation is being
    compelled by the courts. (pp. 47-51)
    AFFIRMED.
    CHIEF JUSTICE RABNER and JUSTICES LaVECCHIA, ALBIN, PATTERSON,
    FERNANDEZ-VINA, and PIERRE-LOUIS join in JUSTICE SOLOMON’S opinion.
    5
    SUPREME COURT OF NEW JERSEY
    A-64 September Term 2019
    084045
    Vincent Hager,
    Petitioner-Respondent,
    v.
    M&K Construction,
    Respondent-Appellant.
    On certification to the Superior Court,
    Appellate Division, whose opinion is reported at
    
    462 N.J. Super. 146
     (App. Div. 2020).
    Argued                      Decided
    December 1, 2020              April 13, 2021
    Matthew Gitterman argued the cause for appellant
    (Biancamano & DiStefano, attorneys; James E.
    Santomauro, on the brief).
    Victor B. Matthews argued the cause for respondent
    (Victor B. Matthews, on the brief).
    Alan Silber argued the cause for amici curiae National
    Organization for the Reform of Marijuana Laws, Garden
    State-NORML, Coalition for Medical Marijuana-NJ and
    Doctors for Cannabis Regulation (Pashman Stein Walder
    Hayden, attorneys; Alan Silber, of counsel and on the
    brief, and Dillon J. McGuire, on the brief).
    Elizabeth R. Leong submitted a brief on behalf of amicus
    curiae of American Property Casualty Insurance
    1
    Association (Robinson & Cole, attorneys; Elizabeth R.
    Leong, on the brief).
    JUSTICE SOLOMON delivered the opinion of the Court.
    Vincent Hager injured his back in a work-related accident in 2001 while
    employed by M&K Construction (M&K). For years thereafter, Hager received
    treatment for chronic pain with opioid medication and surgical procedures to
    no avail. In 2016, he enrolled in New Jersey’s medical marijuana program
    both as a means of pain management and to overcome an opioid addiction.
    Thereafter, a workers’ compensation court found that Hager “exhibit[ed]
    Permanent Partial Total disability” and ordered M&K to reimburse him for the
    ongoing costs of his prescription marijuana (the Order). The Appellate
    Division affirmed.
    Before us, M&K contends that New Jersey’s Jake Honig Compassionate
    Use Medical Cannabis Act (Compassionate Use Act or the Act) is preempted
    as applied to the Order by the federal Controlled Substances Act (CSA).
    Compliance with the Order, M&K claims, would subject it to potential federal
    criminal liability for aiding-and-abetting or conspiracy. M&K also asserts that
    medical marijuana is not reimbursable as reasonable or necessary treatment
    under the New Jersey Workers’ Compensation Act (WCA). Finally, M&K
    2
    argues that it fits within an exception to the Compassionate Use Act and is
    therefore not required to reimburse Hager for his marijuana costs.
    We conclude that M&K does not fit within the Compassionate Use Act’s
    limited reimbursement exception. We also find that Hager presented sufficient
    credible evidence to the compensation court to establish that the prescribed
    medical marijuana represents, as to him, reasonable and necessary treatment
    under the WCA. Finally, we interpret Congress’s appropriations actions of
    recent years as suspending application of the CSA to conduct that complies
    with the Compassionate Use Act. As applied to the Order, we thus find that
    the Act is not preempted and that M&K does not face a credible threat of
    federal criminal aiding-and-abetting or conspiracy liability. We therefore
    affirm the judgment of the Appellate Division.
    I.
    A.
    The appellate record reveals the facts and procedural history pertinent to
    this appeal, and we begin in August 2001, when Hager was employed as a
    laborer for M&K. While working on a residential basement, Hager sought to
    retrieve cement in a wheelbarrow he was using. Something “like an
    explosion” resulted in the cement truck overpouring cement, “hurl[ing Hager]
    into the air” and “smashing [him] and flattening [him] back out like a
    3
    pancake.” Thereafter, Hager experienced sharp back pain that radiated down
    his legs, and he was transferred to light duty. Hager never returned to full duty
    before leaving M&K in December 2001 due to his persistent back pain.
    An MRI revealed spinal disc herniations and bulging and, in November
    2003, Hager underwent a laminectomy and decompression of nerve roots in his
    back. He subsequently underwent a two-level lumbar fusion in September
    2011, but his pain persisted and Hager continued to take prescribed opioid
    medication.1
    In April 2016, Hager began treating with Dr. Joseph Liotta, M.D., a
    hospice and palliative care physician, who enrolled Hager in New Jersey’s
    medical marijuana program both as an alternative pain treatment and as a
    means to wean him off of opioids. Initially prescribed one ounce per month,
    Hager was later prescribed two ounces per month -- the maximum allowable
    prescription -- costing him more than six hundred dollars each month.
    B.
    The procedural history of this matter is somewhat murky and largely
    irrelevant to the issues before us. In sum, Hager petitioned for workers’
    compensation benefits in February 2002. M&K denied the claim the following
    1
    The record shows that since approximately 2006 Hager has received, in addition
    to any medical benefits that may have been provided by M&K, Supplemental
    Security Income and Medicaid benefits.
    4
    month, stating that the accident was being investigated. It was not until
    November 2016 that M&K stipulated that Hager was in its employ and
    suffered a work-related injury. The workers’ compensation trial to determine
    the nature and extent of Hager’s work-related injuries, and any unpaid medical
    benefits to which he was entitled began in November 2016 and continued over
    several scattered days until March 2018.
    At trial, Hager presented the expert testimony of Dr. Liotta, who
    testified that he had diagnosed Hager with post-laminectomy syndrome
    resulting in chronic pain. Hager was also experiencing adverse side effects
    from his opioid medication, according to Dr. Liotta, and was “motivated” to
    cease its use. Hager stopped using opioids after about a month of treatment
    with marijuana. Dr. Liotta noted a “very weak” risk of chemical addiction to
    marijuana and fewer serious, and potentially fatal, side effects as compared to
    opioids. Also, Hager testified on his own behalf that medical marijuana helped
    wean him off opioids, took “the edge off” his pain, and helped with muscle
    spasms.
    Hager also presented the testimony of orthopedist Dr. Cary Skolnick,
    M.D., who testified that Hager required long-term pain management due to his
    “chronic lumbar strain, lumbar herniated discs[,] . . . [and] post-laminectomy
    syndrome.” Dr. Skolnick attributed Hager’s condition to the August 2001
    5
    accident and concluded that he was 100% totally and permanently disabled,
    65% attributable to his back injury and 35% attributable to the effects of his
    medication.
    M&K presented the testimony of orthopedic surgeon Dr. Gregory
    Gallick, M.D., who concluded that Hager was only 12.5% permanently
    disabled and still capable of performing jobs such as driving. Dr. Robert
    Brady, D.O., also testified on behalf of M&K and described the potential side
    effects of medical marijuana, including cognitive difficulties, hallucinations,
    emphysema, chronic obstructive pulmonary disease, and lung cancer. Risks
    associated with opioids, according to Dr. Brady, include overdose, death,
    tolerance, depression, and sexual dysfunction. Though Dr. Brady opined that
    opioids are more physically addictive than marijuana, he represented that the
    two are equally psychologically addictive.
    Citing medical literature, Dr. Brady testified that he did not prescribe his
    patients medical marijuana and added that medical marijuana had not been
    proven effective for conditions such as Hager’s. Dr. Brady opined that brief
    physical therapy followed by a home-exercise regimen represented Hager’s
    “best option” for relief. Dr. Brady did not recommend continued physician
    treatment or pain management because “[u]nfortunately, sometimes people
    have pain.”
    6
    C.
    At the time of the compensation court’s decision, the parties had already
    reached an agreement regarding medical bills, most out-of-pocket medical
    expenses, temporary disability benefits, and third-party lien credits -- leaving
    the court to determine only the nature and extent of Hager’s permanent
    disability and the necessary course of future treatment. The court concluded
    that Hager “exhibit[ed] Permanent Partial Total disability totaling 65%,
    approximately 50% attributable to his orthopedic condition and 15%
    attributable to the effects of the medical marijuana.” The court also found no
    support for M&K’s contention that Hager did not require further treatment.
    Identifying medical marijuana and opioids as the only two choices for
    pain management, the court concluded that “marijuana is the clearly indicated
    option” and ordered M&K to reimburse the costs of Hager’s medical marijuana
    and reasonably related expenses. The court found the testimony of Dr. Liotta
    and Hager to be credible as compared to that of Dr. Brady. Also important to
    the compensation court was Hager’s ability to “conquer his addiction” to
    opioids. The court concluded that “the best interests of the injured worker
    must be a prime consideration under our workers’ compensation scheme. It is
    likewise clear that the legislature intended to make available the benefits of
    medical marijuana to persons displaying a medical need, despite the federal
    7
    attitude toward the substance.” The compensation court also rejected M&K’s
    claim that, like a private health insurer or government medical benefit
    program, M&K could not be required to reimburse the cost of medical
    marijuana.
    The Appellate Division affirmed both the compensation court’s Order
    and, in response to Hager’s cross-appeal, the court’s finding that Hager “had a
    65% permanent partial total disability.” Hager v. M&K Constr., 
    462 N.J. Super. 146
    , 153, 171-72 (App. Div. 2020). After conducting a thorough
    analysis to determine whether the Compassionate Use Act is preempted by the
    CSA in the context of the Order, the Appellate Division concluded that the Act
    did not require employers to do what the CSA proscribes -- possess,
    manufacture, or distribute marijuana. 
    Id. at 162-65
    . Compliance with both
    laws was thus possible, resulting in no positive conflict. 
    Id. at 165
    . The
    Appellate Division also rejected M&K’s contentions that compliance with the
    Order created potential aider-and-abettor liability that both preempted the
    Compassionate Use Act and placed M&K at risk of federal prosecution for
    assisting in Hager’s possession of marijuana. 
    Id. at 165-67
    . The court
    concluded that M&K lacked the requisite intent and active participation to
    support an aiding-and-abetting charge, and did not face a credible threat of
    federal prosecution. 
    Id. at 166-67
    .
    8
    The Appellate Division also rejected M&K’s argument that it should be
    treated like a private health insurer under the Compassionate Use Act and be
    exempt from reimbursing the cost of Hager’s medical marijuana. 
    Id. at 168
    .
    Finally, citing the testimony of Hager and Drs. Liotta and Skolnick, the court
    was satisfied that medical marijuana represents reasonable and necessary
    treatment for Hager. 
    Id. at 170
    .
    We granted M&K’s petition for certification. 
    241 N.J. 484
     (2020). We
    also granted leave to participate as amici curiae to the American Property
    Casualty Insurance Association (APCIA) and to a group of jointly
    participating organizations -- the National Organization for the Reform of
    Marijuana Laws; Garden State - NORML; the Coalition for Medical Marijuana
    - New Jersey; and Doctors for Cannabis Regulation -- which we refer to
    collectively here as “Other Amici.”
    II.
    Before us, M&K reiterates its position that, as applied to the
    compensation court’s Order, the Compassionate Use Act is in actual conflict
    with the CSA because it compels M&K to do what the CSA prohibits -- assist
    in Hager’s possession of marijuana. By reimbursing Hager, M&K argues it
    would be risking federal criminal charges for conspiracy and aiding-and-
    abetting because it will know that Hager is using the reimbursement to pay for
    9
    medical marijuana. Although the Appellate Division concluded that one
    cannot be liable for aiding-and-abetting a completed crime, M&K notes that
    Hager purchases marijuana on a monthly basis and characterizes the offense as
    ongoing.
    M&K also sees no reason to differentiate between private health insurers
    and workers’ compensation insurers; it argues that workers’ compensation
    insurers should be afforded similar protection under the Compassionate Use
    Act and should not be required to reimburse an employee’s medical marijuana
    costs. M&K further contends that medical marijuana is per se an unreasonable
    and unnecessary medical treatment because it is illegal under federal law. It
    adds that marijuana has not been proven to cure or improve back pain and that,
    unlike other medications, the quantity of a given dose of marijuana is at the
    discretion of the patient rather than the prescribing physician.
    The APCIA reiterates M&K’s general assertions, urging us to focus our
    attention on the fact that the Order impermissibly requires what federal law
    prohibits and directing our attention to the recent decision of the Maine
    Supreme Court in Bourgoin v. Twin Rivers Paper Co., 
    187 A.3d 10
     (Me.
    2018), which found in favor of a similarly situated employer. Marijuana use,
    in addition to having unproven medical value, is inconsistent with the safety
    goals of New Jersey’s workers’ compensation scheme, according to the
    10
    APCIA, and affirmance here would hamper employer enforcement of drug-
    free-workplace policies and efforts to prevent employees from being impaired
    on the job.
    Hager counters that the Compassionate Use Act and the CSA are not in
    direct conflict because M&K can comply with both statutes. M&K is not itself
    being asked to engage in conduct violative of the CSA and is not subject to
    liability as an aider-and-abettor because it lacks specific intent, according to
    Hager. Hager adds that M&K faces no credible threat of federal prosecution
    and refers us to the fact that employers and workers’ compensation carriers in
    New Mexico have not faced federal prosecution after being required to
    reimburse employees’ medical marijuana costs. Citing the remedial purpose of
    the WCA and the New Jersey Legislature’s recognition of the medical benefits
    of marijuana in alleviating chronic pain, Hager contends that he is entitled to
    reimbursement.
    Other Amici likewise contend that the CSA and the Compassionate Use
    Act are not in conflict because the latter does not interfere with federal
    enforcement of the CSA, and does not require an employer to possess,
    manufacture, or distribute marijuana in violation of federal law. They describe
    M&K’s aiding-and-abetting argument as a “legal impossibility” because the
    offense is completed by the time of reimbursement. Stressing that the
    11
    compensation court’s finding that marijuana is an appropriate treatment for
    Hager is supported by the medical records and testimony provided, Other
    Amici ask us to affirm.
    III.
    As we turn to M&K’s challenges to the determinations of the
    compensation court, affirmed by the Appellate Division, we are mindful that
    our review of workers’ compensation decisions is “limited to whether the
    findings made could have been reached on sufficient credible evidence present
    in the record.” Hersh v. County of Morris, 
    217 N.J. 236
    , 242 (2014) (quoting
    Sager v. O.A. Peterson Constr., Co., 
    182 N.J. 156
    , 164 (2004)). We
    acknowledge the compensation court’s expertise and the valuable opportunity
    it has had in hearing live testimony, and we thus review its factual and
    credibility findings with “substantial deference.” Goulding v. NJ Friendship
    House, Inc., 
    245 N.J. 157
    , 167 (2021) (quoting Ramos v. M & F Fashions,
    Inc., 
    154 N.J. 583
    , 594 (1998)). However, we review the court’s legal findings
    and construction of statutory provisions de novo. Hersh, 217 N.J. at 243.
    The issues presented in this appeal require consideration of New Jersey ’s
    Compassionate Use Act and the WCA on their own terms and in relation to
    one another, as well as the potential impact of the federal CSA on both state
    statutes. We begin by considering M&K’s state-law based claims.
    12
    IV.
    A.
    The Compassionate Use Act, N.J.S.A. 24:6I-1 to -30, was enacted by the
    New Jersey Legislature in 2010 in recognition of the beneficial uses of
    marijuana and to protect authorized individuals from criminal and civil
    penalties. Wild v. Carriage Funeral Holdings, Inc., 
    458 N.J. Super. 416
    , 427
    (App. Div. 2019), aff’d, 
    241 N.J. 285
     (2020). The Act articulates legislative
    findings that: (1) “[m]odern medical research has discovered a beneficial use
    for cannabis in treating or alleviating the pain or other symptoms associated
    with certain medical conditions”; (2) ninety-nine out of every hundred
    marijuana arrests are made under state law, providing an opportunity to protect
    from arrest many seriously ill individuals in need of marijuana treatment; (3)
    though prohibited under federal law, many other states have legalized medical
    marijuana; and (4) states are not required to enforce federal law, meaning that
    the Act does not place New Jersey in violation of federal law. N.J.S.A. 24:6I-
    2(a) to (d).
    Further, the Legislature, through the Act, seeks to make a “distinction
    . . . between medical and non-medical uses” of marijuana -- a distinction that it
    stresses “[c]ompassion dictates.” 
    Id.
     at -2(e). Accordingly, the Act has “the
    purpose . . . to protect from arrest, prosecution, . . . and criminal and other
    13
    penalties, those patients who use cannabis to alleviate suffering from
    qualifying medical conditions, as well as their health care practitioners,
    designated caregivers, institutional caregivers, and those who are authorized to
    produce cannabis for medical purposes.” Ibid.; see also Wild, 458 N.J. Super.
    at 427; State v. Myers, 
    442 N.J. Super. 287
    , 298 (App. Div. 2015).
    “Qualifying medical condition[s]” include “chronic pain.” N.J.S.A. 24:6I-3.
    The Compassionate Use Act, perhaps most notably, applies the
    provisions of N.J.S.A. 2C:35-18 -- which establishes an affirmative defense to
    criminal liability under state law -- to patients, practitioners, caregivers, and
    others operating in accordance with the Act. N.J.S.A. 24:6I-6(a); see also
    Wild, 458 N.J. Super. at 427; Myers, 442 N.J. Super. at 300. Similarly,
    patients, practitioners, caregivers, and others abiding by the Act cannot be
    subject to any civil or administrative penalties or loss of any right or privilege.
    N.J.S.A. 24:6I-6(b).
    In the employment context, the Compassionate Use Act does not alter
    preexisting employment rights and obligations. See Wild, 458 N.J. Super. at
    428 (discussing the Act as it relates to the New Jersey Law Against
    Discrimination). The Act prohibits an adverse employment action against a
    registered patient “based solely on the employee’s status as a registrant.”
    N.J.S.A. 24:6I-6.1(a). However, the Act does not “require an employer to
    14
    commit any act that would cause the employer to be in violation of federal
    law, that would result in a loss of a licensing-related benefit pursuant to
    federal law, or that would result in the loss of a federal contract or federal
    funding.” Id. at -6.1(c)(2).
    Of relevance to the present matter, the Act provides that reimbursement
    for medical marijuana costs is not required of “a government medical
    assistance program or private health insurer.” N.J.S.A. 24:6I-14. M&K argues
    that it is exempt from reimbursing Hager for his medical marijuana under that
    provision.
    B.
    Based on the plain language of the statute, we agree with the
    compensation court’s determination, affirmed by the Appellate Division, that
    N.J.S.A. 24:6I-14 does not apply to M&K.
    A provision of the statute, entitled “Construction of act,” specifies in
    relevant part that “[n]othing in [the Compassionate Use Act] shall be construed
    to require a government medical assistance program or private health insurer
    to reimburse a person for costs associated with the medical use of cannabis.”
    Ibid. (emphasis added). We read “or” as limiting the applicability of the
    exception to only those two kinds of entities. See Guttenberg Sav. & Loan
    Ass’n v. Rivera, 
    85 N.J. 617
    , 623 (1981) (“The use of the words ‘lessee or
    15
    tenant’ indicates the Legislature had in mind those occupants of residential
    dwelling units who had a certain correlative relationship with someone else ,
    namely, a landlord or lessor. Otherwise the Legislature would have used a
    broader terminology.”). It is “[a] general principle of statutory interpretation .
    . . that ‘exceptions in a legislative enactment are to be strictly but reasonably
    construed, consistent with the manifest reason and purpose of the law.’” Prado
    v. State, 
    186 N.J. 413
    , 426 (2006) (quoting Serv. Armament Co. v. Hyland, 
    70 N.J. 550
    , 558-59 (1976)). Here, reading “or” as a limitation to the coverage
    exemption advances the Act’s overarching and compassion-driven recognition
    of the potential health benefits of medical marijuana. See N.J.S.A. 24:6I-2(e).
    The reading, further, is supported by the definition of “Health insurance”
    in the Life and Health Insurance Code, which unambiguously states “[h]ealth
    insurance does not include workmen’s compensation coverages.” N.J.S.A.
    17B:17-4. If the Legislature sought to depart from that general definition and
    treat workers’ compensation and private health coverage in the same manner
    under the Compassionate Use Act, it could have expressly included workers’
    compensation insurance in its exhaustive list or broadened the exception more
    generally, as other states have explicitly done. See 
    Fla. Stat. § 381.986
    (15)(f)
    (“Marijuana . . . is not reimbursable . . . .”); 410 Ill. Comp. Stat. 130/40(d)
    (“Nothing in this Act may be construed to require a government medical
    16
    assistance program, employer, property and casualty insurer, or private health
    insurer to reimburse a person for costs associated with the medical use of
    cannabis.”); 
    Mich. Comp. Laws § 418
    .315a (“[A]n employer is not required to
    reimburse or cause to be reimbursed charges for medical marihuana
    treatment.”); 
    Mont. Code Ann. § 39-71-407
    (6)(c) (“Nothing in this chapter
    may be construed to require an insurer to reimburse any person for costs
    associated with the use of marijuana . . . .”); Okla. Stat. tit. 63 § 427.8(I)
    (“Nothing in this act . . . shall . . . [r]equire an employer, a government
    medical assistance program, private health insurer, worker’s compensation
    carrier or self-insured employer providing worker’s compensation benefits to
    reimburse a person for costs associated with the use of medical marijuana[.] ”);
    R.I. Gen. Laws § 21-28.6-7(b)(1) (excepting from the requirement to
    reimburse medical marijuana costs a “workers’ compensation insurer, workers’
    compensation group self-insurer, or employer self-insured for workers’
    compensation”); 
    Utah Code Ann. § 26
    -61a-112 (“Nothing in this chapter
    requires an insurer, a third-party administrator, or an employer to pay or
    reimburse for cannabis, a cannabis product, or a medical cannabis device.”).
    We find that the Legislature’s decision not to either list workers’
    compensation carriers or generally broaden the exclusion -- while at the same
    time including “chronic pain” as a qualifying medical condition under the Act,
    17
    N.J.S.A. 24:6I-3, when the WCA covers palliative care, as discussed in the
    next section of this opinion -- places our conclusion here within the clear
    contemplation of the Legislature.
    In sum, we conclude that the Legislature clearly did not intend for
    workers’ compensation insurers to be treated as private health insurers or
    government medical assistance programs under the Compassionate Use Act.
    M&K is therefore not exempt from its reimbursement obligation.
    V.
    A.
    We next consider M&K’s argument that medical marijuana is not a
    “reasonable and necessary treatment” for which the WCA provides coverage ,
    and we begin with the WCA’s legislative history and purpose. The WCA,
    N.J.S.A. 34:15-1 to -146, was enacted in 1911 to compensate workers injured
    in industrial accidents. Richard C. Henke, Workers’ Compensation in New
    Jersey: Toward a Removal of Workers from the Sacrificial Altar of Production
    Quotas, 
    56 Rutgers L. Rev. 789
    , 796 (2004). The scope of the WCA thereafter
    expanded over the decades, id. at 796-97, and benefits payable to injured
    workers increased.
    When it was first enacted, the WCA provided for “reasonable medical
    and hospital services and medicines” up to one hundred dollars during the two
    18
    weeks following an injury. L. 1911, c. 95, § 14. Today, the WCA requires
    employers to provide “such medical, surgical and other treatment . . . as shall
    be necessary to cure and relieve the worker of the effects of the injury,”
    N.J.S.A. 34:15-15, incurred “in the course of employment,” Univ. of Mass.
    Mem’l Med. Ctr., Inc. v. Christodoulou, 
    180 N.J. 334
    , 344 (2004). The statute
    specifies that “[a]ll fees and other charges for such physicians’ and surgeons’
    treatment and hospital treatment shall be reasonable.” N.J.S.A. 34:15-15. If
    an employer refuses or neglects to provide requested necessary treatment or
    services, the injured worker “may secure such treatment and services as may
    be necessary . . . and the employer shall be liable to pay therefor.” 
    Ibid.
    Additionally, the WCA, as enacted and amended, is remedial in nature
    and is to be liberally construed. See, e.g., Squeo v. Comfort Control Corp., 
    99 N.J. 588
    , 604 (1985) (“[T]he construction of an apartment addition may be
    within the ambit of N.J.S.A. 34:15-15.”); Howard v. Harwood’s Rest. Co., 
    25 N.J. 72
    , 88, 94 (1957) (finding that continued nursing-home care was
    “necessary to cure and relieve” the worker’s injuries). Failure to comply with
    a compensation court’s order to pay benefits may lead to imposition of costs,
    fines, and other penalties. N.J.S.A. 34:15-28.2.
    Still, the treatment or services sought by the injured worker “must be
    shown by competent medical testimony to be such as are reasonable and
    19
    necessary for the particular” worker. Howard, 
    25 N.J. at 93
    . Such evidence is
    the “touchstone” of determining what is reasonable and necessary. Squeo, 
    99 N.J. at 606
    ; accord Martin v. Newark Pub. Schs., 
    461 N.J. Super. 330
    , 339
    (App. Div. 2019) (finding that “there was sufficient, credible evidence in the
    record to support the compensation judge’s determination that further
    treatment with opioid medication would not cure or relieve” the worker’s
    condition). The injured worker’s desires or beliefs as to what treatment or
    service will be most beneficial is not determinative. Squeo, 
    99 N.J. at 606
    .
    Further, “it must be shown that [the chosen] treatment is ‘reasonable’ and
    ‘necessary’ to cure or relieve the injury of the worker. A mere showing that
    the injured worker would benefit from the . . . treatment is not enough.” Raso
    v. Ross Steel Erectors, Inc., 
    319 N.J. Super. 373
    , 383 (App. Div. 1999).
    Nevertheless, palliative care may be properly authorized under the
    WCA, and workers who are permanently disabled and beyond hope of being
    cured are still entitled to continued treatment and services. Howard, 
    25 N.J. at 88, 93-94
    ; Hanrahan v. Township of Sparta, 
    284 N.J. Super. 327
    , 333 (App.
    Div. 1995). Competent medical testimony that a particular treatment or
    service will reduce symptoms or restore function is sufficient to satisfy the
    requirement of reasonable and necessary care. Hanrahan, 
    284 N.J. Super. at 336
    .
    20
    B.
    Like the compensation court and the Appellate Division, we too
    conclude that medical marijuana may be found, subject to competent medical
    testimony, to constitute reasonable and necessary care under New Jersey’s
    workers’ compensation scheme. See Howard, 
    25 N.J. at 93-94
    . Our decision
    in Squeo instructs our analysis here.
    The petitioner in Squeo lost the use of his arms and legs at age twenty-
    four following a work-related fall; he argued that a self-contained apartment
    attached to his parents’ home could constitute “other treatment” or “other
    appliance” under N.J.S.A. 34:15-15. 
    99 N.J. at 590-91
    . We affirmed the
    compensation court’s order in favor of the petitioner, finding “that under
    certain unique circumstances, when there is sufficient and competent medical
    evidence to establish that the requested ‘other treatment’ or ‘appliance’ is
    reasonable and necessary to relieve the injured worker . . . the construction of
    an apartment addition may be within the ambit of N.J.S.A. 34:15-15.” 
    Id. at 604, 607
    . In arriving at that conclusion, we looked beyond the petitioner’s
    physical condition and also considered the psychological harm resulting from
    his work-related injuries; that harm was “aggravated” by the then-offered
    treatment -- placement in a nursing home -- which resulted in multiple suicide
    attempts. 
    Id. at 605
    .
    21
    In this appeal, Drs. Skolnick and Liotta persuaded the compensation
    court that Hager remains in chronic pain and that ongoing treatment is
    necessary. Identifying medical marijuana and opioids as the two treatment
    options available, the court concluded, after thoughtful consideration of the
    medical testimony discussing the risks and benefits of each, that marijuana was
    “the clearly indicated option.” Persuasive to the court was marijuana’s ability
    to both provide pain relief and help Hager “conquer his addiction” to opioids.
    Reimbursement payments for the cost of Hager’s prescribed medical
    marijuana -- the treatment ordered here -- may not yet be common, but they are
    certainly less unique than the construction we found appropriate in Squeo.
    Indeed, marijuana’s ability to relieve pain has been expressly recognized by
    the Legislature in the Compassionate Use Act. N.J.S.A. 24:6I-2(a), -3. Thus,
    competent evidence relating to medical marijuana’s ability to restore some of a
    worker’s function or, as in Hager’s case, relieve symptoms such as chronic
    pain and discomfort, is sufficient to find such a course of treatment
    appropriate. See Hanrahan, 
    284 N.J. Super. at 336
    .
    As in Squeo, we recognize the potential harm that may be inflicted on
    Hager by the alternative available treatment. The compensation court noted
    that the record reflected that treatment with opioids had placed Hager on a
    “likely path . . . [of] worsening addiction and ultimately death.” It favored the
    22
    testimony of Hager’s experts over that of M&K’s, which was within its
    discretion to do, that marijuana was comparatively the “appropriate” option to
    address both Hager’s chronic pain and the adverse effects of years of opioid
    use. Rather than “throw [Hager] back to the trash heap,” the court entered its
    Order to reimburse Hager’s marijuana use, both to manage his pain and
    support his efforts to overcome his addiction.
    We agree with the compensation court and Appellate Division that
    exempting workers’ compensation insurance carriers from responsibility for
    workers’ medical marijuana costs would be antithetical to the Legislature’s
    express findings in the Compassionate Use Act and the traditional broad,
    liberal application of New Jersey’s workers’ compensation scheme. Sufficient
    credible evidence in the compensation court record -- medical records and
    hearing testimony -- supported the Order. We will not disturb it. Goulding,
    245 N.J. at 167.
    Having found that M&K is obliged to reimburse Hager under the
    Compassionate Use Act and the WCA, we next consider whether the federal
    CSA -- which classifies marijuana among the most rigorously controlled
    substances and criminalizes the possession and distribution of marijuana, as
    discussed in Section VI.C. below -- extinguishes M&K’s obligations under
    state law.
    23
    VI.
    A.
    We begin our discussion of the intersection of federal and state law here
    with the recognition that New Jersey law diverges from federal law not just as
    to medical marijuana but as to its recreational use as well. Indeed, at present,
    New Jersey’s marijuana laws are undergoing a tectonic shift. In November
    2020, New Jerseyans voted to legalize recreational marijuana via constitutional
    amendment by a two-to-one margin. Troy Closson, Marijuana Is Legal in New
    Jersey, but Sales Are Months Away, N.Y. Times (Feb. 22, 2021),
    https://www.nytimes.com/2021/02/22/nyregion/new-jersey-marijuana-
    legalization.html. As of January 1, 2021, the “growth, cultivation, processing,
    manufacturing, preparing, packaging, transferring, and retail purchasing and
    consumption of cannabis, or products created from or which include cannabis,
    by persons 21 years of age or older . . . shall be lawful and subject to
    regulation by the Cannabis Regulatory Commission.” N.J. Const. art. IV, § 7,
    ¶ 13.
    In February 2021, Governor Philip D. Murphy signed three bills into
    law, giving practical effect to New Jersey’s marijuana legalization. See Press
    Release: Governor Murphy Signs Historic Adult-Use Cannabis Reform Bills
    Into Law (Feb. 22, 2021), https://nj.gov/governor/news/news/562021/
    24
    approved/20210222a.shtml. Though the ability to purchase recreational
    marijuana remains months away, the legislation ended arrests for possession of
    small amounts of marijuana, which numbered in the thousands even after the
    amendment’s effective date. Amanda Hoover, Murphy Signs N.J. Legal Weed
    Bills, Ending 3-Year Saga, NJ.com (Feb. 22, 2021), https://www.nj.com/
    marijuana/2021/02/murphy-signs-nj-legal-weed-bills-ending-3-year-saga.html.
    The most expansive of the three bills, the New Jersey Cannabis
    Regulatory, Enforcement Assistance, and Marketplace Modernization Act,
    amended the Code of Criminal Justice to exempt from any criminal or civil
    punishment possession of six ounces or less of marijuana or seventeen grams
    or less of hashish. L. 2021, c. 16, § 56. Possession of greater quantities is a
    fourth-degree offense. Ibid. A separate bill set forth penalties for the
    possession and use of marijuana by those under the age of twenty-one. See S.
    3454 (2021). The new legislation also prohibits state law enforcement from
    cooperating with federal authorities in enforcing the CSA. L. 2021, c. 16, §
    52.
    While workers may be drug tested under this new regime, an employer
    may not take adverse action against an employee due to the employee’s
    consumption of marijuana or the presence of cannabinoid metabolites in their
    bodily fluid resulting from permitted conduct. Id. § 48. Presence of such
    25
    metabolites may, however, result in penalties or refusal to employ if it causes
    the employer to violate a federal contract or lose federal funding. Id. § 47.
    Those express deferential references to federal law recognize that state law
    may not permit what federal law forbids, a principle as true for our
    recreational use legislation as for our Compassionate Use Act.
    B.
    Notwithstanding New Jersey’s legalization of the medical and
    recreational use of marijuana, the CSA must be considered because, under the
    Supremacy Clause of the United States Constitution, U.S. Const. art. VI, cl. 2,
    “state laws that ‘interfere with, or are contrary to the laws of congress, made in
    pursuance of the constitution’ are invalid.” Puglia v. Elk Pipeline, Inc., 
    226 N.J. 258
    , 274 (2016) (quoting Wis. Pub. Intervenor v. Mortier, 
    501 U.S. 597
    ,
    604 (1991)). The principles of federal preemption are rooted in the Supremacy
    Clause, In re Reglan Litig., 
    226 N.J. 315
    , 328 (2016), which “unambiguously
    provides that if there is any conflict between federal and state law , federal law
    shall prevail,” Gonzales v. Raich, 
    545 U.S. 1
    , 29 (2005).
    “Pre-emption may be either expressed or implied . . . .” Gade v. Nat’l
    Solid Wastes Mgmt. Ass’n, 
    505 U.S. 88
    , 98 (1992). Congress may choose to
    preempt state law with the express language of an enactment. Franklin Tower
    One, L.L.C. v. N.M., 
    157 N.J. 602
    , 615 (1999). In the alternative, there are
    26
    two forms of implied preemption: field and conflict. Reglan, 226 N.J. at 328.
    “Field preemption applies ‘where the scheme of federal regulation is “so
    pervasive as to make reasonable the inference that Congress left no room for
    the States to supplement it.”’” Ibid. (quoting Gade, 
    505 U.S. at 98
    ). Express
    and field preemption do not apply to the present matter, because the CSA
    explicitly leaves room for state law to operate:
    No provision of this subchapter shall be construed as
    indicating an intent on the part of the Congress to
    occupy the field in which that provision operates,
    including criminal penalties, to the exclusion of any
    State law on the same subject matter which would
    otherwise be within the authority of the State, unless
    there is a positive conflict between that provision of this
    subchapter and that State law so that the two cannot
    consistently stand together.
    [
    21 U.S.C. § 903
    .]
    We therefore focus on conflict preemption. “[I]n the absence of express
    language or implied congressional intent to occupy the field, a court must find
    state law to be preempted ‘to the extent that it actually conflicts with federal
    law.’” Maher v. N.J. Transit Rail Operations, Inc., 
    125 N.J. 455
    , 464 (1991)
    (quoting Brown v. Hotel & Rest. Emps. & Bartenders Int’l Union Local 54,
    
    468 U.S. 491
    , 501 (1984)). Conflict preemption requires an actual -- rather
    than hypothetical or speculative -- conflict between federal and state law.
    Feldman v. Lederle Labs., 
    125 N.J. 117
    , 135 (1991).
    27
    Conflict preemption occurs in two scenarios. First, conflict preemption
    arises “where it is ‘impossible for a private party to comply with both state and
    federal requirements.’” PLIVA, Inc. v. Mensing, 
    564 U.S. 604
    , 618 (2011)
    (quoting Freightliner Corp. v. Myrick, 
    514 U.S. 280
    , 287 (1995)). The second
    context in which conflict preemption applies is when “state law ‘stands as an
    obstacle to the accomplishment and execution of the full purposes and
    objectives of Congress.’” Reglan, 226 N.J. at 329 (quoting Gade, 
    505 U.S. at 98
    ). “When there is a conflict, ‘the federal law must prevail.’” Feldman, 
    125 N.J. at 135
     (quoting Free v. Bland, 
    369 U.S. 663
    , 666 (1962)). The importance
    of the state law is immaterial to a conflict preemption analysis when a valid
    federal statute is present. Maher, 
    125 N.J. at 465
    .
    “[P]re-emption is not to be lightly presumed.” Franklin Tower One, 
    157 N.J. at 615
     (quoting Cal. Fed. Sav. & Loan Ass’n v. Guerra, 
    479 U.S. 272
    , 281
    (1987)). “The case for federal pre-emption is particularly weak where
    Congress has indicated its awareness of the operation of state law in a field of
    federal interest, and has nonetheless decided to . . . tolerate whatever tension
    there [is] between them.” Wyeth v. Levine, 
    555 U.S. 555
    , 575 (2009)
    (alteration in original) (quoting Bonito Boats, Inc. v. Thunder Craft Boats,
    Inc., 
    489 U.S. 141
    , 166-67 (1989)).
    28
    Central to our preemption analysis, therefore, is deciphering
    congressional intent. Allis-Chalmers Corp. v. Lueck, 
    471 U.S. 202
    , 208
    (1985) (“[T]he question whether a certain state action is pre-empted by federal
    law is one of congressional intent. ‘“The purpose of Congress is the ultimate
    touchstone.”’” (quoting Malone v. White Motor Corp., 
    435 U.S. 497
    , 504
    (1978))). We must approach that task by examining not only the CSA’s plain
    language, see United States v. Clintwood Elkhorn Mining Co., 
    553 U.S. 1
    , 11
    (2008), but also “the purposes Congress sought to serve” through its
    enactment, see Chapman v. Hous. Welfare Rts. Org., 
    441 U.S. 600
    , 608
    (1979). We must also look beyond the language of the statute to the broader
    framework in which the statute resides. See Village of Ridgefield Park v.
    N.Y., Susquehanna & W. Ry. Corp., 
    163 N.J. 446
    , 453 (2000). Ultimately, a
    determination of “[w]hether a state law stands as an obstacle to the
    accomplishment of a federal objective[] requires a court to consider ‘the
    relationship between state and federal laws as they are interpreted and applied ,
    not merely as they are written.’” R.F. v. Abbott Labs., 
    162 N.J. 596
    , 618
    (2000) (quoting Jones v. Rath Packing Co., 
    430 U.S. 519
    , 526 (1977)).
    With those principles in mind, we turn to the CSA.
    29
    C.
    Enacted by Congress in 1970, the CSA sought “to conquer drug abuse
    and to control the legitimate and illegitimate traffic [of] controlled
    substances.” Raich, 
    545 U.S. at 12
    . The CSA replaced a network of drug laws
    with a “comprehensive regime.” Ibid.; see also 116 Cong. Rec. 33,300
    (statement of Rep. Springer) (“[T]he purpose of this act is to bring together the
    various laws affecting drugs in order to codify and consolidate them. It is
    intended to make enforcement more uniform . . . .”). “Congress intended [for]
    the CSA to strengthen rather than to weaken the prior drug laws.” United
    States v. Moore, 
    423 U.S. 122
    , 139 (1975). The CSA separates controlled
    substances into five schedules based on their accepted medical uses, risk of
    abuse, and physical and psychological effects. Raich, 
    545 U.S. at 13
    .
    Substances may not be placed on a particular schedule without specific
    findings. 
    21 U.S.C. § 812
    (b). The Attorney General is empowered to add,
    remove, and reschedule substances, 
    id.
     § 811(a), and has delegated that
    authority to the Drug Enforcement Administration, United States v. Kelly, 
    874 F.3d 1037
    , 1042 (9th Cir. 2017); 
    28 C.F.R. § 0.100
    (b).
    Marijuana was placed in the strictest schedule -- Schedule I -- at the time
    of the CSA’s enactment. Raich, 
    545 U.S. at 14
    . Substances on Schedule I
    must be found to have a high potential for abuse, no currently accepted use for
    30
    medical treatment, and a lack of accepted safety measures for use under
    medical supervision. 
    21 U.S.C. § 812
    (b)(1). Marijuana remains a Schedule I
    drug today, 
    id.
     § 812(c), Schedule I(c)(10), despite repeated efforts to petition
    for its rescheduling, Nation v. Trump, 
    395 F. Supp. 3d 1271
    , 1275 (N.D. Cal.
    2019). That original placement reflected concerns among legislators at the
    time about the increasing prevalence of marijuana, particularly among young
    people, see 116 Cong. Rec. 33,649-50 (statements of Reps. Anderson and
    Keith), although not all members of Congress agreed that it warranted such
    classification, see 116 Cong. Rec. 33,660 (statement of Rep. Ryan)
    (“[M]arihuana is found on schedule I with such drugs as heroin, morphine, and
    LSD . . . . [T]he studies which have thus far been completed show that
    whatever harmful effects marihuana may have, they are not comparable to the
    effects of the other drugs on schedule I.”).
    Except as otherwise authorized, the CSA makes it unlawful to knowingly
    or intentionally “possess with intent to manufacture, distribute, or dispense, a
    controlled substance.” 
    21 U.S.C. § 841
    (a)(1). The CSA also makes unlawful,
    subject to exceptions, the knowing or intentional possession of a controlled
    substance “unless such substance was obtained directly, or pursuant to a valid
    prescription or order, from a practitioner, while acting in the course of his
    professional practice.” 
    Id.
     § 844(a).
    31
    The “valid prescription” language contained in § 844(a) cannot,
    however, apply to marijuana because the CSA prevents marijuana from being
    validly prescribed. See United States v. Johnson, 
    228 F. Supp. 3d 57
    , 62
    (D.D.C. 2017) (citing United States v. Oakland Cannabis Buyers’ Coop., 
    532 U.S. 483
    , 491 (2001)); United States v. Harvey, 
    794 F. Supp. 2d 1103
    , 1105-
    06 (S.D. Cal.), aff’d, 
    659 F.3d 1272
     (9th Cir. 2011). Thus, marijuana is not
    included in the CSA’s prescription requirements, see 
    21 U.S.C. § 829
    , because
    “for purposes of the [CSA], marijuana has ‘no currently accepted medical use’
    at all,” Oakland Cannabis Buyers’ Coop., 
    532 U.S. at 491
     (quoting one of the
    Schedule I criteria).
    On the enforcement front, guidance from senior personnel in the
    Department of Justice (DOJ) to the offices of the United States Attorneys
    issued over the past decade or so has, at times, deprioritized -- but not
    prohibited -- federal prosecution of marijuana activities that are legal under
    state law. For example, in 2009, Deputy Attorney General David Ogden
    advised United States Attorneys that they “should not focus federal resources .
    . . on individuals whose actions are in clear and unambiguous compliance with
    existing state laws providing for the medical use of marijuana,” but rather
    prioritize larger-scale trafficking operations. Memorandum for Selected
    United States Attorneys 1-2 (Oct. 19, 2009).
    32
    Four years later, as state ballot initiatives sought to legalize possession
    of small quantities of marijuana, Deputy Attorney General James Cole
    reiterated the DOJ’s commitment to enforcing the CSA but provided eight
    priorities in light of limited DOJ resources, which included preventing:
    distribution to minors, marijuana revenue from reaching criminal enterprises,
    violence or the use of firearms in marijuana cultivation and distribution , and
    growth of marijuana on public lands. Memorandum for All United States
    Attorneys 1-2 (Aug. 29, 2013) (2013 Cole Memo). Cole acknowledged the
    DOJ’s traditional reliance on state and local authorities in addressing lower-
    level marijuana activity through enforcement of their own laws and advised
    that states with strong regulatory and enforcement systems were less likely to
    threaten federal priorities. Id. at 2-3.
    Following the change of administrations, Attorney General Jefferson B.
    Sessions, III, advised that “[g]iven the Department’s well-established general
    principles, previous nationwide guidance specific to marijuana enforcement is
    unnecessary and is rescinded, effective immediately.” Memorandum for All
    United States Attorneys 1 (Jan. 4, 2018). Attorney General William Barr
    reversed course to some extent, stating that he was “accepting the Cole
    Memorandum for now,” but that he had “generally left it up to the U.S.
    Attorneys in each state to determine what the best approach is in that state.”
    33
    Sara Brittany Somerset, Attorney General Barr Favors A More Lenient
    Approach to Cannabis Prohibition, Forbes (Apr. 15, 2019),
    https://www.forbes.com/sites/sarabrittanysomerset/2019/04/15/attorney-
    general-barr-favors-a-more-lenient-approach-to-cannabis-legalization/
    ?sh=6e82d477c4c8.
    Significantly, it is not only the Executive Branch that has muddied the
    waters between state marijuana laws and federal enforcement; more
    importantly, Congress has also deprioritized prosecution for possession of
    medical marijuana while leaving the CSA otherwise unchanged.
    In the relevant rider to the most recent federal Appropriations Act,
    Congress prohibited the DOJ from using allocated funds to prevent states,
    including New Jersey, from implementing their medical marijuana laws. See
    Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, § 531, 
    134 Stat. 1182
    , 1282-83 (2020). Specifically, § 531 provides that
    [n]one of the funds made available under this Act to the
    Department of Justice may be used, with respect to any
    of the States of Alabama, Alaska, Arizona, Arkansas,
    California, Colorado, Connecticut, Delaware, Florida,
    Georgia, Hawaii, Illinois, Indiana, Iowa, Kentucky,
    Louisiana, Maine, Maryland, Massachusetts, Michigan,
    Minnesota, Mississippi, Missouri, Montana, Nevada,
    New Hampshire, New Jersey, New Mexico, New York,
    North Carolina, North Dakota, Ohio, Oklahoma,
    Oregon, Pennsylvania, Rhode Island, South Carolina,
    South Dakota, Tennessee, Texas, Utah, Vermont,
    Virginia, Washington, West Virginia, Wisconsin, and
    34
    Wyoming, or with respect to the District of Columbia,
    the Commonwealth of the Northern Mariana Islands,
    the United States Virgin Islands, Guam, or Puerto Rico,
    to prevent any of them from implementing their own
    laws that authorize the use, distribution, possession, or
    cultivation of medical marijuana.
    [Ibid.]
    Similar language has been included in appropriations riders dating back
    to the 2015 federal budget, although the list of states and territories with
    medical marijuana legislation has been expanded over the years to reflect new
    enactments. See Consolidated Appropriations Act, 2020, Pub. L. No. 116-93,
    § 531, 
    133 Stat. 2317
    , 2431 (2019); Consolidated Appropriations Act, 2019,
    Pub. L. No. 116-6, § 537, 
    133 Stat. 13
    , 138 (2019); Consolidated
    Appropriations Act, 2018, Pub. L. No. 115-141, § 538, 
    132 Stat. 348
    , 444-45
    (2018); Consolidated Appropriations Act, 2017, Pub. L. No. 115-31, § 537,
    
    131 Stat. 135
    , 228 (2017); Consolidated Appropriations Act, 2016, Pub. L. No.
    114-113, § 542, 
    129 Stat. 2242
    , 2332-33 (2015); Consolidated and Further
    Continuing Appropriations Act, 2015, Pub. L. No. 113-235, § 538, 
    128 Stat. 2130
    , 2217 (2014); see also United States v. Kleinman, 
    880 F.3d 1020
    , 1027
    (9th Cir. 2017) (noting that the riders for the years 2015 through 2017 were
    “essentially the same” (quoting United States v. Nixon, 
    839 F.3d 885
    , 887 (9th
    Cir. 2016))).
    35
    It appears from the Congressional Record that the impetus for these
    riders has its origins in the Tenth Amendment -- reserving to the states powers
    not granted to the federal government -- and they reflect Congress’s intention
    to limit the role of federal policy in matters of criminal justice. See 160 Cong.
    Rec. H4878 (daily ed. May 28, 2014) (statement of Rep. Rohrabacher) (“It
    should be disturbing to any constitutionalist that the Federal Government
    insists on the supremacy of laws that allow for the medical use of marijuana.”).
    These continuing riders have “changed” federal law by prohibiting the DOJ
    “from spending appropriated funds to prosecute individuals who are acting in
    compliance with their State’s medical marijuana laws” and “restrict[ing] the
    Federal Government from superseding State law when it comes to the use of
    medical marijuana.” 163 Cong. Rec. H311 (daily ed. Jan. 11, 2017) (statement
    of Rep. Rohrabacher).
    The tension between Congress’s appropriations riders and the CSA’s
    classification and criminalization of marijuana is manifest. Mindful that
    preemption analysis turns on legislative intent, see Lueck, 
    471 U.S. at 208
    , we
    turn to case law examining whether and under what circumstances
    appropriations acts -- reflecting a shift in intent with respect to earlier
    legislation -- are deemed to impliedly suspend or supplant the earlier law.
    36
    D.
    In considering the effect of the recent appropriations riders on the CSA
    as applied to the Order, we find particularly instructive guidance from the
    United States Supreme Court and several circuit courts. See Glukowsky v.
    Equity One, Inc., 
    180 N.J. 49
    , 64 (2004) (“[T]he principle of comity instructs
    state courts to give due regard to a federal court’s interpretation of a federal
    statute.”).
    For example, in United States v. Dickerson, the Supreme Court stated
    that “[t]here can be no doubt that Congress could suspend or repeal [an]
    authorization . . . and it could accomplish its purpose by an amendment to an
    appropriation bill, or otherwise.” 
    310 U.S. 554
    , 555 (1940); accord United
    States v. Will, 
    449 U.S. 200
    , 222 (1980). And “although repeals by
    implication are especially disfavored in the appropriations context, Congress
    nonetheless may amend substantive law in an appropriations statute, as long as
    it does so clearly.” Robertson v. Seattle Audubon Soc’y, 
    503 U.S. 429
    , 440
    (1992) (citation omitted); see also Me. Cmty. Health Options v. United States,
    590 U.S. ___, 
    140 S. Ct. 1308
    , 1323-27 (2020) (concluding that Congress’s
    failure to fund Patient Protection and Affordable Care Act obligations did not
    impliedly repeal the ACA). Harmonizing conflicting statutes is preferred, but
    courts are not required to “approach the statute[s] with blinders and reconcile
    37
    them at all costs, even when the second enactment is an appropriations
    measure.” Preterm, Inc. v. Dukakis, 
    591 F.2d 121
    , 133 (1st Cir. 1979).
    Though it did not discuss implied repeal, United States v. McIntosh
    tasked the Ninth Circuit with resolving an issue similar to the one at hand --
    determining whether the 2016 appropriations rider prohibiting DOJ
    interference with state medical marijuana laws prevented the DOJ from
    prosecuting activities allegedly compliant with state law. 
    833 F.3d 1163
     ,
    1168-70 (9th Cir. 2016). The court concluded that it did, stating that “at a
    minimum, [the rider] prohibit[ed the] DOJ from spending funds from relevant
    appropriations acts for the prosecution of individuals who engaged in conduct
    permitted by the State Medical Marijuana Laws and who fully complied with
    such laws.” Id. at 1176-77. In so concluding, the Ninth Circuit recognized the
    “temporal nature” of the issue -- Congress could restore funding for such
    prosecutions any day or never again -- but concluded that, if the DOJ sought to
    continue prosecuting the appellants, the appellants were entitled to evidentiary
    hearings to determine whether they strictly complied with state law. Id. at
    1179; see also Tin Cup, LLC v. U.S. Army Corps of Eng’rs, 
    904 F.3d 1068
    ,
    1073 (9th Cir. 2018) (“There is . . . ‘a very strong presumption’ that if an
    appropriations act changes substantive law, it does so only for the fiscal year
    for which the bill was passed.” (quoting Bldg. & Constr. Trades Dep’t, AFL-
    38
    CIO v. Martin, 
    961 F.2d 269
    , 273 (D.C. Cir. 1992))); Strawser v. Atkins, 
    290 F.3d 720
    , 734 (4th Cir. 2002) (“‘Where Congress chooses’ to amend
    substantive law in an appropriations rider, ‘[courts] are bound to follow
    Congress’s last word on the matter even in an appropriations law.’” (quoting
    City of Los Angeles v. Adams, 
    556 F.2d 40
    , 49 (D.C. Cir. 1977))).
    Those federal decisions ring familiar because they mirror our own
    reading of appropriations acts as signifiers of legislative intent to suspend
    earlier statutory enactments. See City of Camden v. Byrne, 
    82 N.J. 133
    , 154-
    55 (1980). In Byrne, a collection of municipalities and counties brought
    actions against Governor Brendan T. Byrne, the Legislature, and other
    government officials for failure to appropriate and expend state funds allotted
    by several statutes to municipalities and counties. 
    Id. at 141-44
    . The
    allocations were not made because they were excluded from the Legislature’s
    general appropriations acts or eliminated by Governor Byrne’s line-item veto.
    
    Id. at 142-44
    .
    After discussing the constitutional issues implicated in the matter, we
    moved to the defendants’ contention that the statutes had been suspended,
    supplanted, or repealed by the subsequent passage of annual appropriations
    acts, which intentionally excluded the expenditures. 
    Id. at 153
    . The
    appropriations acts and original statutes were irreconcilable because they made
    39
    different uses of the same limited funds. 
    Ibid.
     Although we recognized a
    strong presumption against any implied nullification of statutes , we concluded
    that “this presumption may be overcome when there is a clear showing that
    two legislative measures are patently repugnant or inconsistent.” 
    Id. at 154
    .
    To so find, we looked to the intent of the Legislature. 
    Ibid.
    Applied to the facts presented in Byrne, we found that the failure to
    appropriate the funding called for in the statutes was an intentional act of the
    Legislature, as was its decision not to override the Governor’s line-item
    vetoes. 
    Ibid.
     Such unmistakable legislative intent reflected in the
    appropriations laws “necessarily supersede[d] any previously expressed
    legislative desires at least for the duration of the particular appropriation act. ”
    
    Ibid.
     We thus read the appropriations acts as the manifested intent of the
    Legislature to give no effect at all to the earlier statutes, stating that “[t]he
    earlier statutes [could not] coexist with the enacted appropriation and ,
    consequently, must be deemed [to have been] suspended by adoption of the
    later appropriation acts.” 
    Id. at 154-155
    .
    We noted, as well, the limited applicability of appropriations laws --
    confined to a particular fiscal year -- and concluded that their effect on the
    previously enacted statutes was best expressed as implied suspension as
    opposed to implied repeal, even though that limitation did not change our
    40
    general analysis. 
    Id. at 153-54
    ; see also McIntosh, 833 F.3d at 1179
    (recognizing the “temporal nature” of Congress’s appropriations rider as
    applied to DOJ enforcement of the CSA). Our courts continue to recognize
    appropriations acts as expressions of legislative intent. See Guaman v. Velez,
    
    421 N.J. Super. 239
    , 258 (App. Div. 2011); Mid-Atl. Solar Energy Indus.
    Ass’n v. Christie, 
    418 N.J. Super. 499
    , 505-06 (App. Div. 2011).
    E.
    With federal case law and Byrne as our guides to deciphering
    congressional intent here, we conclude that it is possible for M&K to abide by
    both the CSA and the Compassionate Use Act at the present time, and that the
    latter does not currently create an obstacle to the accomplishment of
    congressional objectives. As such, the Compassionate Use Act is not
    preempted by the CSA as applied to the Order.
    The perceived tension, as stated, stems from the Order entered against
    M&K. See N.J.S.A. 34:15-28.2 (providing for penalties that may be imposed
    on employers and insurers that fail to comply with compensation court orders).
    Though the Compassionate Use Act shields those acting in compliance with its
    provisions from criminal liability, see N.J.S.A. 24:6I-6(a), marijuana
    possession remains illegal under federal law, 
    21 U.S.C. §§ 841
    (a), 844(a).
    This despite Congress’s present will to defund DOJ actions that prevent states
    41
    from implementing their own medical marijuana laws, Consolidated
    Appropriations Act, 2021, Pub. L. No. 116-260, § 531, 
    134 Stat. 1182
    , 1282-
    83 (2020), including prosecuting those complying with state law, see
    McIntosh, 833 F.3d at 1176-77.
    Byrne instructs us to read statutes and subsequent appropriations acts in
    tandem. To do as M&K asks -- to focus purely on whether state law permits
    and, in this case, demands what federal law forbids -- would be to completely
    disregard the most recent expression of Congress’s intent in its appropriations
    acts. See Strawser, 290 F.3d at 734. We find that doing so would be
    incongruous with the task before us and do not so limit ourselves here. We
    must also consider the broader framework in which the statutes exist. See
    Village of Ridgefield Park, 
    163 N.J. at 453
    .
    Here, the CSA expressly contemplates a role for state law absent a
    “positive conflict” with the CSA. See 
    21 U.S.C. § 903
    ; see also Gonzales v.
    Oregon, 
    546 U.S. 243
    , 251 (2006) (discussing Schedule II controlled
    substances). DOJ guidance has acknowledged both federal prosecutors’
    historic reliance on state and local laws and law enforcement in addressing
    lower-level marijuana offenses and the fact that state marijuana laws generally
    do not conflict with federal investigative and prosecutorial priorities. 2013
    Cole Memo, supra, at 2-3. The Compassionate Use Act thus seeks to operate
    42
    in the space afforded to it by federal law and federal priorities. See N.J.S.A.
    24:6I-2(c) to (d) (noting the collection of other states that have enacted similar
    medical marijuana programs and finding that the Act does not place New
    Jersey in violation of federal law).
    Congress has, for seven consecutive fiscal years, prohibited the DOJ
    from using funds to interfere with state medical marijuana laws through
    appropriations riders. The present rider and its predecessors have “changed”
    federal law and “restrict[ed] the Federal Government from superseding State
    law when it comes to the use of medical marijuana.” See 163 Cong. Rec.
    H311 (daily ed. Jan. 11, 2017) (statement of Rep. Rohrabacher). The rider
    language leaves “no doubt” as to its effect by “forbid[ding] the use of funds”
    to interfere with state medical marijuana schemes. See The Last Best Beef,
    LLC v. Dudas, 
    506 F.3d 333
    , 339-40 (4th Cir. 2007) (holding that “Congress
    intended to enact a discrete and narrow exception to the Lanham Act” via an
    appropriations action). Despite McIntosh’s inviting correction by Congress,
    833 F.3d at 1179 (“If Congress intends to prohibit a wider or narrower range
    of DOJ actions, it certainly may express such intention, hopefully with greater
    clarity, in the text of any future rider.”), those riders have used substantially
    the same language year after year. It appears to us that this repeated language
    is Congress speaking with complete awareness of McIntosh and absolute
    43
    approval of its reasoning. See 163 Cong. Rec. H311 (daily ed. Jan. 11, 2017)
    (statement of Rep. Rohrabacher) (“Importantly . . . the Ninth Circuit Court of
    Appeals ruled in [McIntosh] that Federal funds cannot be used to prosecute
    those in compliance with their State’s medical marijuana laws. This provision
    will be part of American law as long as it is renewed and Congress makes it
    part of the law.”). Congress is empowered to amend the CSA via an
    appropriations action provided “it does so clearly,” see Robertson, 
    503 U.S. at 440
    , and the most recent appropriations rider, in our view, “clearly is intended
    as a substitute” to the CSA as applied to the Compassionate Use Act, see
    Miccosukee Tribe of Indians of Fla. v. U.S. Army Corps of Eng’rs, 
    619 F.3d 1289
    , 1299 (11th Cir. 2010). Therefore, we find that Congress has spoken
    through the most recent appropriations rider and give it the final say.
    Strawser, 290 F.3d at 734; Adams, 
    556 F.2d at 48-49
    .
    We thus conclude that the CSA, as applied to the Compassionate Use
    Act and the Order at issue, is effectively suspended by the most recent
    appropriations rider for at least the duration of the federal fiscal year and that
    it would be “inappropriate for this Court to give any legal effect whatsoever to
    the earlier statutory enactment[].” Byrne, 
    82 N.J. at 154-55
    . “The earlier
    statute[] cannot coexist with the enacted appropriation and, consequently, must
    be deemed to be suspended by adoption of the later appropriation act[]. ” 
    Id.
     at
    44
    154. We repeat that “[t]he case for federal pre-emption is particularly weak
    where Congress has indicated its awareness of the operation of state law in a
    field of federal interest, and has nonetheless decided to . . . tolerate whatever
    tension there [is] between them.” Wyeth, 
    555 U.S. at 575
     (second alteration in
    original) (quoting Bonito Boats, Inc., 
    489 U.S. at 166-67
    ).
    As in Byrne, we find here that this clear, volitional act in the form of
    appropriations law takes precedence over the earlier legislation. Because DOJ
    enforcement of the CSA may not, by congressional action, interfere with
    activities compliant with the Compassionate Use Act, we find that there is no
    “positive conflict” and that the CSA and the Act may coexist as applied to the
    Order. See 
    21 U.S.C. § 903
    . Qualified patients may continue to possess and
    use medical marijuana, and related compensation orders may be entered while
    federal authorities continue to enforce the CSA to the extent Congress permits.
    The federal and state acts can thus “consistently stand together,” see ibid., and
    it is possible for M&K to comply with both, see Mensing, 
    564 U.S. at 618
    .
    The Compassionate Use Act does not currently present an obstacle to
    Congress’s objectives as articulated in the recent appropriations riders, see
    Reglan, 226 N.J. at 329, and so the CSA does not preempt the Compassionate
    Use Act as applied to the Order. As we have previously recognized, and we
    find to be the case here with respect to the recent appropriations riders’ effect
    45
    on the CSA, “legislative intent through appropriation actions . . . sometimes
    speak[s] louder than words.” State v. Cannon, 
    128 N.J. 546
    , 568 (1992).
    We acknowledge that our decision here departs from the holdings of
    other state supreme courts that have come to different conclusions when faced
    with the precise issue before us -- whether state medical marijuana laws are
    preempted as applied to workers’ compensation orders compelling employers
    to reimburse workers’ medical marijuana costs. See Bourgoin, 187 A.3d at 22
    (“Because the CSA preempts the [Maine Medical Use of Marijuana Act] when
    the [Act] is used as the basis for requiring an employer to reimburse an
    employee for the cost of medical marijuana, the order based on the [Act] must
    yield.”); Wright’s Case, 
    156 N.E. 3d 161
    , 175 (Mass. 2020) (concluding that
    the plain language of the state reimbursement limitation provision prohibited
    compelling workers’ compensation insurers to reimburse the cost of medical
    marijuana).
    We are urged to follow suit with Bourgoin and Wright’s Case.
    However, while we may find their reasoning instructive, they in no way bind
    our Court or predetermine our analysis. See Matthews v. City of Atl. City, 
    84 N.J. 153
    , 162 (1980). Our decision today is consonant with our reading of the
    relevant federal authorities and our settled principles of preemption analysis
    and deciphering legislative intent.
    46
    Additionally, after oral argument, the New Hampshire Supreme Court
    concluded that there is “no direct conflict” between the CSA and a state order
    to reimburse a worker’s medical marijuana costs and that reimbursement did
    not represent an obstacle to congressional objectives. Appeal of Panaggio, ___
    A.3d ___, ___ (N.H. 2021) (slip op. at 6, 11). Agreeing with the Bourgoin
    dissent and our Appellate Division’s decision in this case, Panaggio also found
    that the insurer would lack the active participation and mens rea necessary for
    aiding-and-abetting liability, 
    id.
     ___ (slip op. at 8), which we will address in
    the next section.
    We close by repeating the “temporal nature” of the issue before us and
    its dependence on the future acts of Congress. See McIntosh, 833 F.3d at
    1179. Funding to support federal prosecution of those acting within the scope
    of the Compassionate Use Act may be restored soon, or never again. We
    regard the CSA as suspended, rather than repealed, with respect to orders like
    the one at issue here because the appropriations rider on which we rely is of a
    limited lifespan and may be repeated, removed, or changed within the year.
    See Byrne, 
    82 N.J. at 153
    .
    F.
    Our preemption analysis notwithstanding, we address M&K’s contention
    that its compliance with the Order would subject it to aiding-and-abetting
    47
    liability under 
    18 U.S.C. § 2
     on the theory that it would be assisting in Hager’s
    possession of marijuana, contrary to the CSA. M&K counters the Appellate
    Division’s conclusion “that ‘one cannot aid and abet a completed crime,’”
    Hager, 462 N.J. Super. at 166 (quoting United States v. Ledezma, 
    26 F.3d 636
    ,
    642 (6th Cir. 1994)), by claiming that the offense at issue here is ongoing as
    opposed to completed. It similarly argues that its compliance risks conspiracy
    liability under 
    21 U.S.C. § 846
    . We are unpersuaded.
    “To aid and abet a crime, a defendant must not just ‘in some sort
    associate himself with the venture,’ but also ‘participate in it as in something
    that he wishes to bring about’ and ‘seek by his action to make it succeed.’”
    Rosemond v. United States, 
    572 U.S. 65
    , 76 (2014) (quoting Nye & Nissen v.
    United States, 
    336 U.S. 613
    , 619 (1949)). Proof is required “that the
    defendant had the specific intent to facilitate the crime.” United States v.
    Centeno, 
    793 F.3d 378
    , 387 (3d Cir. 2015). To support an aiding-and-abetting
    conviction, “the Government must prove: ‘(1) that another committed a
    substantive offense; and (2) the one charged with aiding and abetting knew of
    the commission of the substantive offense and acted to facilitate it.’” 
    Ibid.
    (quoting United States v. Mercado, 
    610 F.3d 841
    , 846 (3d Cir. 2010)).
    “[W]hether he participates with a happy heart or a sense of foreboding” is of
    48
    no matter, provided the accomplice “knowingly elected to aid in the
    commission of” the offense. Rosemond, 572 U.S. at 79-80 (emphasis added).
    By the very nature of its appeals to both the Appellate Division and this
    Court, M&K has made it clear that it does not wish to “participate” and “act[]
    to make . . . succeed” the federal offense in question here -- Hager’s
    possession of marijuana. It has gone to great pains to avoid facilitating an
    offense. We trust that our affirmance of the compensation court’s Order will
    not change M&K’s position. Likewise, reimbursing Hager under court
    mandate can hardly be interpreted as M&K “elect[ing]” to aid in Hager’s
    possession of marijuana, contrary to federal law. Rather, it is being compelled
    to do so by the Order.
    Even accepting M&K’s contention that the court-mandated
    reimbursement payments constitute an ongoing offense in which the
    reimbursement for one illegal purchase and possession enables the next, it fails
    to show -- and we strain to find -- how its compliance with the Order exhibits a
    specific intent to aid-and-abet Hager’s marijuana possession. M&K’s position
    that it faces aiding-and-abetting liability because it will reimburse Hager while
    knowing what the funds will be used for does not persuade us that it satisfies
    the specific intent requirement when the facts so clearly indicate that it will be
    doing so against its will and at the behest of this Court.
    49
    M&K’s argument that compliance with the Order places it at risk of
    conspiracy liability must also fail for similar reasons. Any individual who
    conspires to commit an offense prohibited by the CSA “shall be subject to the
    same penalties as those prescribed for the offense.” 
    21 U.S.C. § 846
    . A
    conspiracy charge under § 846 “can only be sustained if the defendant
    ‘knowingly and intentionally became a member of the conspiracy.’” United
    States v. Ruiz, 
    932 F.2d 1174
    , 1182 (7th Cir. 1991) (quoting the Seventh
    Circuit’s Pattern Criminal Federal Jury Instructions for conspiracy). “[T]he
    government must show . . . that the alleged conspirators shared a ‘unity of
    purpose[,’] the intent to achieve a common goal, and an agreement to work
    together toward the goal.” United States v. Korey, 
    472 F.3d 89
    , 93 (3d Cir.
    2007) (quoting United States v. Cartwright, 
    359 F.3d 281
    , 286 (3d Cir. 2004)).
    Again, we are unable to discern a “unity of purpose” from M&K’s
    repeated attempts to disassociate itself from Hager’s marijuana possession and
    use. The parties are of two competing minds on the subject and M&K went as
    far as to present testimony before the compensation court that Hager does not
    require any treatment at all -- let alone the ongoing prescription of medical
    marijuana. Likewise, to the extent that the Order requiring reimbursement
    payments creates a conspiracy between Hager and M&K, M&K’s membership
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    cannot be said to be intentional. Rather, its participation is being compelled
    by the courts.
    VII.
    The judgment of the Appellate Division is affirmed. M&K is ordered to
    reimburse costs for, and reasonably related to, Hager’s prescribed medical
    marijuana.
    CHIEF JUSTICE RABNER and JUSTICES LaVECCHIA, ALBIN,
    PATTERSON, FERNANDEZ-VINA, and PIERRE-LOUIS join in JUSTICE
    SOLOMON’S opinion.
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