The Pennsylvania congressman who appears to be President Trump's choice for national drug czar has a track record that is making him a lightning rod for criticism in the drug-treatment community and among advocates for patients' rights.
Tom Marino, a former district attorney and federal prosecutor from Williamsport, is a well-known drug warrior. A staunch opponent of legalizing both medical and recreational marijuana, Marino also has advocated locking up non-violent drug offenders until they submit to treatment.
As drug czar, Marino would oversee the Office of National Drug Control Policy, which advises the president on drug issues and coordinates national and global anti-drug efforts. His appointment as the office's director would require Senate confirmation.
The Republican was one of the first members of Congress, along with fellow Pennsylvania Rep. Lou Barletta, to openly support Trump's presidential candidacy. At campaign rallies, Trump saluted Marino and Barletta, nicknaming them "Thunder and Lightning." The pair remain among the president's most vocal and loyal advocates.
Marino, a self-described "deplorable," also has been one of the most vociferous opponents of the Affordable Care Act. Better known as Obamacare, the ACA has helped provide more access to drug treatment services to poor people under an expanded Medicaid program.
In Congress, Marino voted multiple times against protecting residents of states where cannabis is legal from prosecution under federal drug laws, rejected allowing the Veterans Affairs Department to administer medical marijuana to veterans, and cast votes against measures that would allow industrial hemp.
Marino has said he recognizes that the nation is suffering from a substance abuse epidemic. In 2015, there were more than 52,400 overdose deaths, and nearly 13,000 of those fatalities related to heroin, according to the American Society of Addiction Medicine. The situation has hit Pennsylvania particularly hard, and is felt acutely in parts of Philadelphia and the suburbs.
It's Marino's get-tough solutions his critics find troubling. In congressional testimony, Marino said drug abusers should be held in "a secured hospital-type setting under the constant care of health professionals."
After people pleads guilty to drug possession charges, Marino said, they should be placed under "intensive treatment program until experts determine they should be released under intense supervision. If this is accomplished then the charges are dropped against that person."
Many advocates say forcing treatment isn't legal and wouldn't work.
"I'm not sure it would pass constitutional muster," said Roseanne Scotti, director of the Drug Policy Alliance in New Jersey. "No medical professional would think this is a good idea. No expert on treatment would think it was a good idea."
Forcing treatment is rarely, if ever, effective, Scotti said. For instance, heroin users who return to the street after a court-mandated stint frequently die of an overdose soon after release because they have reduced their tolerance for the drug, but don't receive the support they need afterward to stay clean.
"We're not just setting them up for failure," Scotti said. "We're setting them up to die."
Repeated calls to Marino's office on Thursday requesting comment were not returned. His office was closed in observance of Good Friday.
Marino's allies, however, say he's just what the nation needs.
"This will be wonderful if the president picks Tom," said Rob Gleason, the former chair of the Pennsylvania Republican Party, who helped guide Marino on his ascent to Congress.
According to Gleason, the Trump administration is considering re-elevating the drug czar position back to a cabinet-level post. As recently as February, Trump weighed eliminating the Office of National Drug Control Policy, which Marino is now in line to direct.
"The really good thing is that it's not an afterthought," Gleason said. "This could be a momentous step in the War on Drugs."
Val DiGiorgio, a Chester County attorney and current chair of the Republican Party of Pennsylvania, described Marino as "a simple country lawyer" who worked hard to rise to national prominence.
"He's definitely not a hardliner. He's more pragmatic," DiGiorgio said. "But he's definitely a conservative."
The opioid epidemic, DiGiorgio said, "is such a problem in Pennsylvania, and as a former prosecutor, Tom understands and is more plugged-in than most."
Others take a darker view of the three-term congressman and his agenda.
"He just says that people should be committed to a hospital/prison. This involuntary commitment of everyone who is a recreational drug user is bizarre and not workable," Bates said. "The cost would be exorbitant and the effect on liberty would be terrifying. "
Chris Goldstein, a marijuana legalization advocate and cannabis columnist for Philly.com, said treatment facilities are overtaxed and few beds are available for those who need them most.
"We're already at capacity," Goldstein said. "We'll have to build scores of treatment prisons just to deal with that new population."
Roland Lamb, deputy commissioner of Philadelphia's Department of Behavioral Health and Intellectual disABility Services, said he was "generally disappointed" that the Trump administration had chosen to focus on drugs as a criminal-justice matter. Attorney General Jeff Sessions has committed to what many consider a failed war on drugs and Trump recently appointed Gov. Christie, also a former federal prosecutor, to lead the commission to combat opioid abuse.
"It's not as simple as just saying no," Lamb said. "The solutions require action that is much deeper than that."
Lamb said hundreds of thousands of Americans become dependent on opioids each year after receiving a legitimate prescription for opioid painkillers. "They were saying yes to pain management and ended up addicted," Lamb said.
As a congressman, Marino tussled over drug policy with Obama appointees. He was once accused by a top Drug Enforcement Administration official of "supporting criminals" by putting the interests of pharmaceutical companies ahead of controlling the opioid epidemic.
Marino co-sponsored a prescription drug bill that the head of the DEA's diversion program later said was a "gift to the industry." The DEA's Joseph Rannazzisi claimed the legislation — which passed unanimously in 2016 and was signed into law by President Barack Obama — prevented the agency from cracking down on companies that broke the law by not reporting suspicious orders of dangerous drugs.
Marino shot back, accusing Rannazzisi of intimidation and "serious misconduct."