ALBANY - Medical marijuana is looming as the most prominent issue that Gov. Andrew M. Cuomo and state lawmakers face in the second half of the 2014 legislative session, with proponents stepping up efforts to make New York the 21st state to legalize it.

It's part of a nationwide effort to loosen marijuana laws for patients, including those suffering from cancer and epilepsy.

Cuomo remains opposed to a broad medical marijuana program -- even as a growing number of legislators have voiced support, citing stories by patients who say medical marijuana has eased seizures and chronic pain.

Others, such as Sen. Phil Boyle (R-Bay Shore), are pushing for a third alternative: legalizing oils derived from marijuana but prohibiting dispensing medical marijuana in a smokable format.

Cuomo, a Democrat who is up for re-election and is said to be considering a 2016 presidential run, shifted his position subtly this year. With support growing in the legislature, the governor proposed a limited medical marijuana research program.

He supports reviving an obscure 1980 law to begin a research program in which 20 hospitals could dispense medical marijuana with certain conditions. The program would use pot seized in drug busts.

"I'm not proposing a law, so it's not the legislature telling me what I have to do," Cuomo has said. "And that gives me great comfort because if it goes bad, we can correct or improve all within our own control."

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The Democrat-dominated Assembly supports a broader form of legalization, sponsored by Assemb. Richard Gottfried (D-Manhattan) and Sen. Diane Savino (D-Staten Island).

Under the bill, a physician, physician's assistant or nurse practitioner would certify that a patient has a severe debilitating or life-threatening condition that "can and should be treated with medical marijuana" for therapeutic or palliative benefit. The state Health Department would license and regulate dispensers, who would have to comply with detailed security requirements.

Like Cuomo, Senate Republicans have been opposed to the Gottfried-Savino bill -- but a growing number from Western New York have changed their position and support it, saying they are convinced it can help patients with certain conditions.

"Prolonging 'research' studies is an insult to the thousands of New Yorkers who are suffering from debilitating illnesses and clamoring for real relief," Savino said in an email. "Twenty states . . . have made the correct decision to safely adopt medical marijuana and are providing compassionate care to their residents at this very moment. This simple fact is all the research we need."

Savino said Cuomo's plan has "huge red flags" and she questions whether the federal government would allow hospitals to distribute pot. She said she would accelerate her campaign for her and Gottfried's bill when the Senate returns from its Easter/Passover break on April 23.

Patients and their families who support Savino's bill are mobilized, traveling to the State Capitol repeatedly in an organized effort to win over state lawmakers.

"There are plenty of people on Long Island who want this and who are struggling," said Tracy Ofri, a Valley Stream resident who has multiple sclerosis. "Time is of the essence."

Ofri, like other advocates, said Cuomo's plan is a positive gesture but contends it is cumbersome and would help only a small percentage of patients in chronic pain. Advocates also note the plan would rely on marijuana confiscated by police, which does not have the same purity standards as pharmaceutical-grade pot.

"We don't have any idea how many people are going to be able to participate," Ofri said of the governor's plan. "We need legislation that has more patient access to help a greater number of people."

Missy Miller of Atlantic Beach said she's tried almost 20 medications to ease the seizures endured by her son, Oliver, 14, who has a brainstem injury and uses a wheelchair.

"But the seizures just keep getting worse and worse," said Miller, who believes medical marijuana may help her son cope with Lennox-Gastaut syndrome, a severe form of epilepsy. She said she sees "kids in states like Colorado" experience a reduction in seizures, through the use of medical marijuana.

One treatment group supports Cuomo's approach over Savino's. Jeffrey Reynolds, executive director of the Long Island Council on Alcoholism and Drug Dependence, said the senator's bill lists too many medical conditions for treatment and sets the marijuana possession level too high.

Advocates are focusing on Senate co-leader Dean Skelos (R-Rockville Centre) and key senators to allow a vote on medical marijuana.

"He told me to be patient," Miller said of Skelos, after a recent meeting, their third on the issue. "This is not something my son has time to wait for."

Senate Republicans are studying the issue, a spokesman said. Skelos recently softened his opposition to some forms of medical marijuana, saying he is open to legalizing marijuana-based oils and possibly vaporizers.

"My own personal feeling, I don't like the idea of the smoking, public smoking," Skelos said at the time. "I think some people have made their case in terms of the oil, especially with kids that have hundreds of seizures a day. I think they've been very effective and I'm trying to learn a little bit more about the vaporizers."

Boyle's bill addresses some of those issues. "Almost without exception, legislators want to provide needed relief to those young children who suffer from seizures and those who can benefit from truly medical marijuana," Boyle said. "The only question is what delivery systems would be permitted, and most oppose a smoking option."

Many took note when the No. 2 Republican in the Senate said he's reconsidering the issue. State Sen. Thomas Libous (R-Binghamton), who has battled prostate and lung cancer, is undergoing chemotherapy. Asked if he would try pot, Libous said in a radio interview last month: "If it became legal and it became available to everyone, I would."