THE PROGNOSIS

California Gov. Jerry Brown’s veto of a bill that would have allowed San Francisco to open the nation’s first sanctioned safe injection site disappointed advocates and paused one experimental effort to fight the opioid epidemic.

In his veto statement, the California Democrat said “enabling illegal and destructive drug use will never work.” The facilities would allow users a space to use illegal drugs with clean instruments and under the supervision of health-care workers.

“Fundamentally, I do not believe that enabling illegal drug use in government sponsored injection centers — with no corresponding requirement that the user undergo treatment — will reduce drug addiction,” Brown wrote. “Both incentives and sanctions are needed. One without the other is futile.”

Laura Thomas, deputy California state director for the Drug Policy Alliance, called Brown’s veto message “shocking.”

“It just portrayed a profound misunderstanding of what these programs are,” she said. “We spent so much time educating the legislature, having committee hearing after committee hearing, experts come into testify, and then he’s leaning on very outdated concepts about what it takes to help people heal from substance use disorder.”

She said what his statement got wrong was the idea that mandating drug users to get treatment will be effective. Thomas said that’s the “opposite of what works.”

The bill would have allowed San Francisco to open the first government-sanctioned supervised injection site in the nation. Philadelphia, Seattle and New York are other cities considering opening these sites as a way to address drug use, but none of them now currently exist in the United States. Advocates point to research from some of the approximately 100 sites worldwide to show they benefit public health.

Alex Kral, an epidemiologist for the nonprofit research group RTI International, explained to me back in April that his years of research found sites can reduce drug users’ risk of infections from HIV and hepatitis, reduce overdose fatalities and help users find resources such as drug treatment programs or social services.

Brown's veto came the week the Senate approved a sweeping opioid measure that President Trump is expected to soon sign. That federal bill creates, expands and reauthorizes programs and policies across almost every agency, aiming to address different aspects of the opioid epidemic, including prevention, treatment and recovery.

It was a rare bipartisan response in Washington to the 72,000 overdose deaths last year, and part of a multi-faceted federal and state attempt to grapple with a complex problem. Advocates have been urging public officials to adopt safe injection sites as one response to the crisis.

Brown, however, said the disadvantages of such sites outweigh their potential benefits.

Advocates of the facilities say they aren’t giving up the fight.

Democratic California State Sen. Scott Wiener, who sponsored the bill along with Democratic Assemblywoman Susan Eggman, said the pair is “committed” to bringing back the bill in the next legislative term, when Brown will be termed out.

California Lt. Gov. Gavin Newsom (D), who is running to succeed Brown, split with the governor on the issue, saying he would consider approving a pilot site if elected.

“I’m very open to that. I’d like to learn more about why the governor vetoed it in terms of making what I believe is a legal argument — so I’d like to research that,” Newsom said during a campaign event, the San Francisco Chronicle reported. “I’m not wedded to the language of the existing bill, but I am certainly very, very open to a pilot.”

Wiener, who said he believes Newsom will win the gubernatorial race, said that endorsement was a big win for the effort.

“Having our likely next governor come out in support, that’s a big deal and it helps create the political momentum we need,” he said.

But even if a revived effort would have legs under another governor, advocates still face barriers at the federal level.

In his statement, Brown cited the Trump administration’s vehement opposition to supervised injection sites, noting it has “already threatened prosecution and it would be irresponsible to expose local officials and health-care professionals to potential federal criminal charges.”

In an August New York Times op-ed, Deputy Attorney General Rod J. Rosenstein criticized the sites as a “taxpayer-sponsored haven to shoot up” and warned that “cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action.”

Wiener said the veto message shows the Trump administration’s warnings were on Brown’s mind when he rejected the bill. But he expressed doubt the federal government would follow through on its threats. “I’m skeptical the federal government would arrest and prosecute nurses and social workers who are simply doing their jobs and helping people. That’s not a good look for the Department of Justice.”

Thomas said she did not believe the administration’s threats had a role in Brown’s decision.

“Normally, Jerry Brown is fine taking on the federal government,” Thomas said.

Wiener says safe injection sites can be part of the “all-of-the-above” approach needed to address opioid addiction.

“We need more resources for treatment of opioid addiction, we need more health-care access for people who are struggling with addiction, we need needle exchanges,” he said. “And we need safe injection sites.”

AHH, OOF and OUCH

AHH: Not all Democrats are convinced that “Medicare-for-all” is the right way to go, and the issue has Democrats divided as they hit the final weeks of campaign trail ahead of the midterm elections, the Wall Street Journal’s Stephanie Armour reports.

Democrats are “split on whether to promise coverage for everyone, which would fuel an already revved-up liberal base, or target centrist voters by campaigning on the more modest goal of fixing the Obama-era health law,” she writes.

Some experts say Democrats should have instead rallied behind a unifying message as they challenge Republicans on health care, which polls show is a top issue for voters. Stephanie notes that a recent poll from Reuters-Ipsos found 70 percent of people support “Medicare-for-all” while 41 percent say they support “single-payer,” she notes, “reflecting the importance of labeling.”

“They’re missing the boat,” Robert Blendon, a health-policy professor at Harvard University, told Stephanie. “The message of Democrats should be that ‘unless we get the House and Senate, they’re going to take preexisting conditions away.’ But there’s no coherent message in the ads.” And Stephanie adds centrist Democrats are concerned the "Medicare for all" mantra could alienate voters they need to take back control from Republicans.

OOF: During his rally last night in Minnesota, Trump called on his supporters to turn out in November and said Democratic control of Congress would jeopardize Medicare. He also claimed that money derived from the trade war with China would protect those with preexisting conditions from losing coverage.

"A Democratic controlled Congress would also pose a grave threat to Medicare," Trump said. He criticized the push for "Medicare-for-all" -- "It's really Medicare for none," Trump said -- and said Democrats' plan "would rob American seniors of benefits they have paid. And they've paid these benefits and they've paid so much money for their entire lives." 

"Republicans want to protect Medicare for our great seniors who have earned it and who have paid for it," Trump continued. 

Trump also reiterated his vow that Republicans "will always protect Americans with preexisting conditions." (The preexisting conditions fight is heating up on the campaign trail, with Democrats touting the idea Republicans want to remove protections because of a lawsuit many state officials have brought to overturn the Affordable Care Act; Republicans argue they want to preserve protections for sick people trying to get insurance).

Last week, during a rally in West Virginia, Trump also said protections for preexisting conditions are "safe." 

"Some of the Democrats have been talking about ending preexisting conditions," Trump said last night, then suggesting that one way the government can fund coverage for preexisting conditions would be to "get a little bit more money from China." 

"You know what I say? We'll get a little bit more money from China, we'll be fine. We'll be just fine," he said. "We're going to take care of preexisting conditions, remember that."

Following Trump's remarks in West Virginia, FactCheck.org wrote Trump's comments claiming preexisting conditions are "safe" were misleading. 

"Trump’s comments contradict the Justice Department’s actions, which Trump approved," FactCheck.org's Lori Robertson wrote, referring to the lawsuit brought by 20 states against the ACA. "We can’t predict what future steps the administration might take if the plaintiffs are successful in the Texas case. But it’s disingenuous for the president to say he 'will always fight for, and always protect, patients with preexisting conditions,' when his Justice Department, with his approval, has decided not to fight — and instead side with the plaintiffs — in a lawsuit that could end such patient protections," Lori writes.

OUCH: The trauma of sexual assault or harassment may have lasting effects on women’s health, according to new research.

The new study from the Women's Behavioral Health Laboratory at the University of Pittsburgh assessed the experience of about 300 women ages 40 to 60. The women “had been recruited for a study on menopause and cardiovascular disease — not sexual harassment or assault,” NPR’s Mara Gordon reports, adding that the women were asked “if they had ever experienced sexual harassment at work. Participants were also asked if they had ever ‘been made or pressured into having some type of unwanted sexual contact.’”

It found that 22 percent of the surveyed women reported being sexually assaulted, and 19 percent said they had experienced workplace sexual harassment, Mara reports. A fourth of the women who had been sexually assaulted met the standard for depression. By comparison, 1 in 10 women who had not been sexually assaulted were depressed.

“Though the sample size was small, the results are statistically significant,” Mara writes. “Women who had experienced sexual assault had on average an almost threefold increased risk of developing depressive symptoms, compared to women who hadn't. They also had a greater incidence of clinically significant anxiety.”

HEALTH ON THE HILL

— HuffPost’s Kevin Robillard zooms in on one district in Michigan where health care is a central issue, no less so because Republican Rep. Fred Upton’s opponent Matt Longjohn is a doctor and the former national health director for the YMCA.

“Not surprisingly, Longjohn is focused on health care — and Upton’s role in passing Obamacare repeal through the House,” Kevin writes. He adds that although Upton has never earned less than 55 percent of the vote in his district, there are signs the race could be competitive.

“Smaller Democratic groups are up on the air attacking Upton over his health care vote, and trying to persuade the district’s residents their longtime congressman can no longer be trusted," Kevin  adds. “But those ads are being canceled out by a spot from the American Hospital Association, which is airing ads boosting Upton even though they officially opposed his amendment and the GOP’s entire Obamacare repeal effort.”

TRUMP TEMPERATURE

— Supreme Court nominee Brett M. Kavanaugh inched closer to confirmation following the release of the much-anticipated FBI report on sexual misconduct allegations against the judge as Republicans argued the report revealed nothing disqualifying. The Senate is set for a key procedural vote on the nomination today at 10:30a.m.  

“Sen. Susan Collins (Maine) and Jeff Flake (Ariz.) — two decisive Republican votes — indicated Thursday that the additional FBI probe was adequate, although they both cautioned they would continue to read the closely held report,” our colleagues Seung Min Kim and John Wagner report, with the help of a team of Post colleagues. “Flake also told reporters that ‘we’ve seen no additional corroborating information’ to bolster the allegation from Christine Blasey Ford, who in emotional testimony last week said that Kavanaugh sexually assaulted her when they were teenagers.”

Sen. Lisa Murkowski (R-Alaska), a third key vote, has not said how she will vote. Neither has Sen. Joe Manchin III (D-W.Va.), who said he planned to continue Friday studying the FBI report in a secure room at the Capitol. One Republican senator, Sen. Steve Daines (R-Mont.), announced he will be at his daughter’s wedding on Saturday, the day of the final confirmation vote. “But Daines’s vote will not be needed Saturday unless one Republican defects and Democrats stay unified against Kavanaugh,” Seung Min and John write.

Retired Justice John Paul Stevens, a Republican, chimed in, saying Thursday in Florida, according to the Palm Beach Post, that Kavanaugh’s temperament at the hearings “changed his views” about the nominee and disqualified him.

For his part, Kavanaugh acknowledged in an op-ed in the Wall Street Journal that he was “very emotional” during the hearing and vowed he would be “even-keeled, open-minded, independent and dedicated to the Constitution and the public good” as a judge moving forward.

Meanwhile, our colleagues Devlin Barrett and Matt Zapotosky report that while Republicans insisted the FBI report told them what they need to know, "Democrats and representatives for those who claimed to have been victimized by [Kavanaugh] angrily denounced the FBI’s background check... asserting that the bureau, shackled by the White House, did not pursue obvious leads that could have helped corroborate the allegations the Supreme Court nominee faced." 

—The president again defended his Supreme Court nominee during his Minnesota rally, calling Kavanaugh "incredible." 

"Democrats have been trying to destroy judge Brett Kavanaugh since the very first second he was announced," he said. "Because they know that judge Kavanaugh will protect, uphold and defend the Constitution of the United States as written." 

STATE SCAN

— The Iowa Farm Bureau will now ask applicants for its health coverage whether they have a range of illnesses and will be able to reject certain applications or raise prices for people with preexisting conditions, the Des Moines Register’s Tony Leys reports.

The new plans will not technically be insurance, Tony explains. The controversial plans are alternatives to insurance plans, and are expected to have lower premiums than standard health plans. “Iowa is allowing the new policies’ sale under a law passed last spring that declared the Farm Bureau coverage would technically not be insurance, so it would not have to follow state or federal insurance regulations,” Tony writes. The plans thus don’t have to comply with the ACA.

One main difference between standard plans and the new plans from the farm bureau is the ability to determine whether applicants have preexisting illnesses.

“Supporters say the new plans will be a lower-cost option for some Iowans who don’t have employer-provided health insurance and who make too much money to qualify for federal subsidies toward premiums on individual insurance,” Tony continues. “Critics fear the new, unregulated plans could siphon healthy Iowans away from standard health insurance plans, driving up premiums for other customers.”

MEDICAL MISSIVES

— Leon Lederman, a Nobel Prize-winning experimental physicist who died this week at the age of 96, had to sell his prize in 2015 to help pay for his medical bills.

The University of Chicago professor won the Nobel Prize in physics in 1988 along with two other scientists for “discovering a subatomic particle called the muon neutrino,” the Associated Press’s Keith Ridler reports. In 2011, Lederman began experiencing memory loss and moved to Idaho when his symptoms became more severe, his wife told the AP. Four years later, he sold his Nobel Prize for $765,000 at an auction to help pay for his medical care.

Lederman died at a nursing home in Rexburg, Idaho.

— And here are a few more good reads from The Post and beyond: 

New Hampshire's Democratic U.S. senators are introducing separate but related legislation aimed at lowering health care costs.
Associated Press
Planned Parenthood's political arm is targeting vulnerable GOP Sen. Dean Heller on comments he made about the sexual assault allegations against Supreme Court nominee Brett Kavanaugh. 
The Hill
Colorado’s Obamacare insurers will raise rates for 2019 by an average 5.6 percent, a state official announced Thursday, but customers that get financial help are set to see a decrease of 24 percent.
Washington Examiner
Local
The challenge in prosecuting such crimes often begins with getting victims to come forward.
Courtland Milloy
World
Denis Mukwege, a Congolese gynecologist, treated victims of gang rape, and Nadia Murad is a Yazidi activist kidnapped and held by the Islamic State.
Chico Harlan and Max Bearak
Social Issues
Amid Kavanaugh debate, parents of D.C.’s prep-school boys wrestle with conversations about sexual assault
Samantha Schmidt
Business
A radical move by one of North America's biggest life insurers has experts questioning whether the company could reshape the model for the industry -- by building business around helping its customers live longer.
Taylor Telford
The company says its app can predict your mood based on how you use your phone. But almost no one outside Mindstrong has seen data on how well it works.
Stat
Inspired Life
Dr. Daniel McNeely – who had never tweeted before – posted two photos of the moment. Twitter loved them.
Allison Klein
Local
Victims of sexual violence challenged senators to “believe survivors” and vote “no” on Brett M. Kavanaugh’s nomination.
Marissa J. Lang and Gabriel Pogrund contributed to this report.
Politics
Video of the incident ricocheted around social media on Thursday, the latest in a string of videos to capture the heated emotions around the Kavanaugh nomination.
Eli Rosenberg
Politics
“Boy, did he fold up like a wet rag, huh?” Trump said Thursday night at a rally in Minnesota.
Josh Dawsey and Felicia Sonmez
DAYBOOK

Today

  • The Alliance for Health Policy holds a briefing on improving care for children with complex medical needs.
SUGAR RUSH

'Women are angry': Anti-Kavanaugh protesters march before Senate vote:

First lady Melania Trump visits baby elephants in Kenya: