President Donald Trump’s pick to head the nation’s war on drugs: a man who once said drug users belong in a “hospital-slash-prison.”

Last week, Trump announced his nomination of Rep. Tom Marino, a Republican from Pennsylvania, to head the Office of National Drug Control Policy (ONDCP) — making Marino, should the Senate approve him, the nation’s new drug czar.

Marino is a former federal prosecutor with a history of voting against drug policy reforms. That puts him in line with other Trump administration figures — particularly Attorney General Jeff Sessions — who have moved from the more public health–oriented approach to drugs advocated by President Barack Obama’s administration in favor of cracking down on drugs more through the criminal justice system. Given that Marino and Sessions will guide the offices most connected to federal drug policy, this suggests Trump is really intent on escalating the war on drugs.

Marino’s voting record suggests he’s to the right of many of his Republican colleagues on the war on drugs. After he assumed office in 2011, he voted against a bipartisan measure (which ultimately passed) that blocked the US Department of Justice from cracking down on medical marijuana businesses in states where medicinal pot is legal. He voted against a bill that would’ve let Veterans Affairs doctors recommend medical marijuana to patients. He opposed loosening restrictions on hemp and CBD, both of which are nonpsychoactive but have promising, respectively, industrial and medical uses.

Marino did say that marijuana is “a states’ rights issue,” but his voting record suggests that he’s fine with the Justice Department cracking down on state-legal marijuana businesses. And he argued that “the only way I would agree to consider legalizing marijuana is if we had a really in-depth medical scientific study. If it does help people one way or another, then produce it in pill form.” (Pennsylvania, Marino’s home state, last year legalized medical marijuana.)

Medical marijuana legalization is generally the most easily supported of all drug policy reforms, with polls showing it at 80-plus percent public support. Marino’s views on this issue, then, suggest he’s generally to the right on drugs.

There’s other evidence to this end. Marino also once argued for incarcerating drug users, even those not involved in drug dealing, in a “hospital-slash-prison”:

One treatment option I have advocated for years would be placing non-dealer, nonviolent drug abusers in a secured hospital-type setting under the constant care of health professionals. Once the person agrees to plead guilty to possession, he or she will be placed in an intensive treatment program until experts determine that they should be released under intense supervision. If this is accomplished, then the charges are dropped against that person. The charges are only filed to have an incentive for that person to enter the hospital-slash-prison, if you want to call it.

And as a former federal prosecutor and district attorney, Marino has a law enforcement background that may drive him toward leveraging the criminal justice system over the public health care system to address drug crises. (Although there appear to be personal exemptions: In a controversial case, Marino in 1998 shopped around for judges as a district attorney to try to get a friend, Pennsylvania car dealer Jay Kilheeney, cleared of a cocaine conviction.)

At the same time, Marino also seems quite friendly to the pharmaceutical industry. He’s received thousands in donations from drugmakers. He also in 2016 pushed for a bill that effectively made it harder for the Drug Enforcement Administration (DEA) to crack down on irresponsible pharmaceutical companies, which have in recent years caused the worst drug overdose crisis in US history through the opioid epidemic. Legal drug manufacturers, suppliers, and sellers backed the bill.

But as head of the drug czar’s office, Marino likely wouldn’t have much of a role in shaping policy for legal drugmakers, which are mostly left to the Food and Drug Administration (FDA). In fact, whether Marino will have power at all comes down to how seriously Trump’s administration takes the drug czar’s office.

The drug czar’s office has shaped policy in the past

The existence of a drug czar goes back to President Richard Nixon, who established the position through the Special Action Office for Drug Abuse Prevention. But with the Anti-Drug Abuse Act of 1988, the office was elevated and rebranded by Congress as the Office of National Drug Control Policy (ONDCP).

While the drug czar under Nixon actually took a surprisingly progressive public health approach to drugs, it moved toward focusing more on drugs as a criminal justice issue over the years and especially with the establishment of ONDCP. In the middle of the crack cocaine epidemic of the 1980s and ’90s, President George H.W. Bush named drug hardliner Bill Bennett to head the agency.

In ONDCP’s first national drug control strategy, Bush and Bennett set a clear tone: In the table of contents, the first item for “National Priorities” is “The Criminal Justice System,” not treatment or prevention.

“It was a culture war document,” David Courtwright, a drug policy historian at the University of North Florida, previously told me. “It’s very much a statement about personal responsibility, zero tolerance, directed law enforcement to crack. It was very much a drug war document.” He added, “In terms of actual impact on policy [and] media coverage, it’s a very big deal in the late ’80s.”

The document exemplifies what the drug czar typically does: He sets the tone for the national conversation on drugs. Whether that leads to actual policy changes depends on whether the president and Congress actually accept the drug czar’s advice — since the office itself does not have much direct power in terms of changing policy.

ONDCP “is in an advisory capacity,” Courtwright said. “If you go back and look at the national drug control strategy documents, they make suggestions. They prioritize programs. … But do they actually set policy? I guess they do if the president and Congress say it’s a good plan and do it.”

Still, the history suggests that Congress and the president do tend to follow what the drug czar says on drug policy issues.

In this way, the office has recently taken a more public health–oriented approach to drugs. Under Obama drug czar Michael Botticelli, the office proposed the first drug control budget in decades that would have spent more on treatment and prevention programs than law enforcement and interdiction. Botticelli, who himself struggled with alcohol addiction, also repeatedly said that “we can’t arrest and incarcerate addiction out of people.”

The Obama administration and Congress took Botticelli seriously, passing in 2016 the Cures Act, which, among other measures, allocated $1 billion for drug treatment over two years to confront the opioid epidemic. And although Congress didn’t approve the last budget proposal put forward by Obama’s ONDCP (because Congress never approved a full budget for that fiscal year), under Obama federal anti-drug spending did generally shift toward more treatment and prevention.

As drug czar, Marino seems poised to move away from this approach. Although he did vote for the Cures Act, his record on marijuana and stated views on incarcerating drug users suggests he takes a view more in line with Bennett than Botticelli.

That could lead to real policy consequences. The Trump administration already rolled back Obama-era memos that asked federal prosecutors to lay off low-level drug offenses. It might do the same for memos that effectively allowed states to legalize marijuana without much federal interference — letting federal law enforcement crack down on drugs, including marijuana in states where it’s legal. It could shift anti-drug spending, although it would need congressional approval for much of it, to focus more on law enforcement and interdiction than public health programs.

Whether the country actually moves in Marino’s preferred direction will depend on whether Trump, his administration, and Congress actually take Marino and the drug czar’s office seriously. But so far there are many signs, on top of Marino’s appointment, that suggest Trump is serious about moving the country in the kind of direction that Marino has advocated for in the past.

Trump wants to escalate the war on drugs

Over the years and on the campaign trail, Trump has by and large taken a “tough on crime” view, including toward drugs.

In 2015, Trump outright told MSNBC that he’s “tough on crime.” He praised Vice President Mike Pence for increasing mandatory minimum sentences for drug crimes as governor of Indiana. He falsely claimed that the murder rate is at a 45-year high when it’s actually near a historical low. And he said police should be more aggressive than they are today, particularly by using the controversial “stop and frisk” strategy that a court struck down in New York City because it was used to target minority Americans.

Sessions, Trump’s attorney general, has taken a similar view. In his last year in the Senate, he was key in killing a criminal justice reform bill that would have relaxed prison sentences for low-level drug offenders. He criticized police reforms led by the Obama administration during a November 2015 Senate hearing called “The War on Police.” He said that “good people don’t smoke marijuana” while arguing against pot legalization. And as attorney general, Sessions has criticized states where marijuana is legal.

One potential contradiction to much of this is Trump’s pick of New Jersey Gov. Chris Christie (R) to head an opioid epidemic commission. Christie has long spoken about treating addiction as primarily a public health problem instead of a criminal justice issue. And the commission’s preliminary recommendations reflected that, focusing on how the president could improve access to drug addiction treatment. Still, it’s unclear whether Trump is actually acting on the commission’s recommendations.

For people watching closely, then, Marino’s nomination is the latest piece of evidence about where Trump is trying to move the country.

“If President Trump were to name to this position someone who has a prominent political profile as a ‘law and order’ person, is a former prosecutor, or is a Jeff Sessions type, I think that would definitely be a signal that the old drug war is coming back,” Courtwright said.

“Or,” he added, “if you’re a cynic, the person is just a ‘law and order’ placeholder in an agency that’s not going to do anything and is just another bone that you throw to the conservative base. And then you go around doing whatever you were going to do in terms of drug policy.”

This could be the one bright spot for drug policy reformers: Trump’s administration is so perpetually mired in chaos and in-fighting that it’s hard to gauge whether it can fully accomplish the “tough on crime” goals it’s set.

It’s also true that reverting the country on drug policy will require approval not just from Congress, but state and local lawmakers who have increasingly moved toward a softer approach on drugs in light of the opioid epidemic. So Trump and Sessions could face some big obstacles there.

So while the White House is signaling its preference for the old style of combating drugs with the Marino pick, it’s a bit of a mystery if the signaling will translate to real policy changes.