“I'm not great at the advice. Can I interest you in a sarcastic comment?”

This is what ‘Friends’ actor Matthew Perry’s character Chandler Bing was known for. He was known for being funny. However, he had his own struggles in his personal life and those struggles were acute depression. He was treating it with ketamine infusion therapy which is legal in the US and the UK.

What is Ketamine infusion therapy?

Ketamine is an anaesthetic used to treat depression, anxiety and pain under supervised and controlled medical settings. However, it does have its side effects, which can lead to distortion of sight, sound and time. It can also produce calming and relaxing effects.

Ketamine increases a person’s heart rate and blood pressure. If overdosed, it can leave users confused and agitated and can cause them to hurt themselves without even realising it. It can also lead to liver damage and bladder problems.

However, when used in moderation and under the supervision of medical doctors, it can treat depression where traditional antidepressants have failed.

Prof Rupert McShane, a University of Oxford psychiatrist who runs an NHS ketamine treatment clinic told BBC that ketamine “probably turns off the area of the brain that is involved in disappointment.”

Can Ketamine Infusion Therapy Kill Someone?

In simple terms, it cannot, be if the dosage is given in a controlled setting and as prescribed. Ketamine infusion therapy uses drugs in small doses than those used for anaesthesia. It acts faster than traditional anti-depressants, but the effects also wear off way quickly. Which is why it is important to monitor patients’ mental state for relapsing back into depression and discouraging them from overdosing on it.

There are ways of giving people ketamine. One of the ways is through “infusing”, which means to use an IV drip. However, injections, nasal sprays and capsules are also methods used to give people ketamine.

Since the dosage of ketamine used in the infusion treatment is small, it being the reason of actor Perry’s death was ruled out. The medical examiner also noted that Perry’s last ketamine infusion therapy session happened more than a week before his death, which means by the time he had died, it must have worn off.

So, What Happened To Perry?

Though Perry’s last session was more than a week before, his post-mortem showed that his blood contained a high concentration of ketamine. He had died of the “acute effects” of ketamine.

If it was not his session, then how did he get ketamine?

Prosecutors alleged that his assistant gave him at least 27 shots of ketamine in four days before his death, reported BBC.

Perry has been open about his personal struggles and this is what the doctors and dealers used against him. Martin Estrada, the US attorney for California’s Central District told the BBC that people took advantage of his condition. They charged him 165 times more than what vials of ketamine cost.

Names that have come up include Dr Salvador Plasencia, drug dealers “Ketamine Queen” aka Jasveen Sangha and Eric Fleming, and Perry’s live-in assistant Kenneth Iwamasa.

Who Are These Names And What Did They Do?

Ketamine Queen or Sangha supplied drugs that led to Perry’s death. Her home was a “drug-selling emporium,” said Estrada. More than 80 vials of ketamine, and thousands of pills including methamphetamine, cocaine and Xanax were allegedly found in her house known as the “Sangha Stash House.”

Sangha is known to deal with high-end celebs and was a “major source of supply for ketamine to others as well as Perry,” said Estrada.

Dr Plasencia called Perry a “moron” while charging him $2,000 for vials that cost only $12. He sold Perry 20 vials of ketamine between September and October 2023, costing $55,000.

He was the one who taught Iwamasa, who had no medical knowledge to inject the drug. This is after he knew that “Perry’s ketamine addiction was spiralling out of control,” as per what the investigators told the BBC.

Another dealer Fleming was told by Sangha to “delete all our messages.” While Fleming pleaded guilty to conspiring to distribute drugs unlawfully, he also allegedly messaged Sangha: “Please call...Got more info and want to bounce ideas off you. I’m 90% sure everyone is protected. I never dealt with [Perry] only his assistant. So the assistant was the enabler.”

The court documents also revealed that he asked Sangha on whether the ketamine stays in your system or “is it immediately flushed out.”

Dr Pepper, Bots, Cans

The people who allegedly exploited Perry used coded language for ketamine and called it “Dr Pepper”, “bots”, or “cans.”

Selling overpriced drugs, taking advantage of Perry’s mental condition and falsifying medical records to make the drugs given to him look legitimate by Dr Plasencia is what took Perry’s life.

Iwamasa is said to have administered more than 20 shots of ketamine and three on the day Perry died. Whereas ketamine is only administered by a physician. Authorities also found that weeks before Perry’s death, Dr Plasencia allegedly bought 10 vials of ketamine and intended to sell to Perry.

He also injected Perry with a large dose, two days later. This caused him to “freeze up” and spiked his blood pressure.

When I Die, I Want Helping Others To Be The First Thing That’s Mentioned

Perry had always been open about his drug addictions, struggles with alcohol and his depression. He said that his openness would help others who are also struggling and wanted to be remembered by his quote which also is on the homepage of the Mattew Perry Foundation that helps others struggling with the disease of addiction: “When I die, I want helping others to be the first thing that’s mentioned.”

Five arrests have been made in the case so far.

Amid an India-wide strike of more than 15 lakh chemists and druggists slated for May 20, the government today noted that access to medicines will remain unaffected in the country.

“All pharmacy chains and hospital pharmacy stores, Jan Aushadhi stores, AMRIT Pharmacy stores will remain open tomorrow,” according to official sources from the Ministry of Health.

These stores will remain open “in addition to the many state and chemist associations who have already pulled out from the strike,” the sources said.

Retail pharmacy associations from at least 12 states and Union Territories, including West Bengal, Kerala, Maharashtra, Punjab, Karnataka and Uttar Pradesh, have formally distanced themselves from the strike call, citing “public interest”.

What Is The Nationwide Chemists’ Strike About?

Earlier this week, the All India Organisation of Chemists and Druggists (AIOCD) announced that more than 15 lakh chemists and druggists across the country will keep their medical stores shut on May 20 to protest against illegal online sale of medicines and “unprofessional competition” by corporate firms.

The trade body flagged the sale of prescription drugs without proper verification and warned that AI-generated fake prescriptions may worsen the misuse of antibiotics.

The nationwide strike also demands the withdrawal of notifications issued during the COVID-19 pandemic that allegedly enabled the misuse of online medicine sales, said AIOCD president and former MLC Jagannath Shinde during a press conference in Mumbai.

Shinde noted that online sales had led to the circulation of fake drugs, antibiotics, and scheduled medicines without prescriptions, posing a serious threat to public health, particularly among the youth.

Also read: ‘I Was Vocal About Cancer But Silent About Menopause Out Of Shame’, Says Actress Lisa Ray

“The online sale of drugs has become hazardous for the nation and needs to be checked on priority. Moreover, deep discounts offered by online companies were proving to be a death knell for small chemists and retailers,” he alleged.

During the COVID pandemic, the government had issued special exemptions to ensure home delivery of medicines. Shinde pointed out that those provisions are continuing even after the pandemic ended.

Online companies were exploiting these relaxations and engaging in unfair competition through discounts ranging from 20 to 50 per cent, he added.

CDSCO Reviewing Retail Pharmacy Concerns

Read More: No Ebola Case in India, Public Risk Low: Govt Steps Up Surveillance at Airports and Seaports

Official sources in the Central Drugs Standard Control Organisation (CDSCO) reiterated that public health and patient access to medicines remain paramount.

They noted that any disruption in the functioning of chemist shops has the potential to cause serious inconvenience to patients, particularly vulnerable groups dependent on regular access to life-saving and essential medicines, besides impacting critical medical supply chains.

“Any disruption in the functioning of chemist shops has the potential to cause serious inconvenience to patients and impact critical medical supply chains,” a source said.

They also added that constructive dialogue remains the preferred mechanism for addressing sectoral concerns while ensuring uninterrupted healthcare services for citizens across the country.

The 17th outbreak of Ebola virus in the Democratic Republic of the Congo has claimed over 130 lives, with more than 513 suspected cases, local officials have said.

A spokesperson for the DR Congo government said cases were now being reported across a wider area, according to the BBC. Cases are now being identified in new areas, including Nyakunde in Ituri Province, Butembo in North Kivu, and the city of Goma.

As per the US Centers for Disease Control and Prevention (CDC), there are also two confirmed cases and one death in Uganda.

The World Health Organization (WHO) has declared the current outbreak, caused by the Bundibugyo virus, an international emergency. The agency has also warned that it could potentially become “a much larger outbreak” than what is currently being detected and reported, with a significant risk of local and regional spread. However, it does not meet the criteria of a pandemic.

Meanwhile, an American doctor in the DR Congo who was caring for patients also tested positive for Ebola Bundibugyo disease on May 17.

“The person developed symptoms over the weekend and tested positive late on Sunday,” the CDC said, adding that the agency is working to move the patient to Germany for treatment and care.

CBS News also quoted sources as saying that at least six Americans have been exposed to the Ebola virus during the outbreak in the DR Congo.

The CDC noted that "high-risk contacts associated with this exposure are also being moved to Germany".

The Bundibugyo Virus: Previous Outbreaks

The Bundibugyo virus has previously caused two recognised outbreaks. The first was in Bundibugyo District, Uganda, in 2007–2008, with 131 reported cases and 42 deaths, and a case fatality rate of 34–40 per cent.

The second was in Isiro, Democratic Republic of the Congo, in 2012, with 38 laboratory-confirmed cases and 13 deaths, although wider outbreak reports, including probable and suspected cases, gave higher totals.

These figures are lower than the fatality rates seen in many outbreaks caused by other Ebola strains, but they are still extremely serious.

Also read: Ebola Outbreak: University of Glasgow Researcher Explains Why Bundibugyo Virus Is Concerning

The largest outbreak of the Ebola virus since its discovery in 1976, took place in 2014–2016. The outbreak infected more than 28,600 people in West Africa.

The disease also spread to several countries within and outside West Africa, including Guinea, Sierra Leone, the United States, the United Kingdom, and Italy, killing 11,325 people.

How Does Ebola Bundibugyo Spread?

The Bundibugyo virus spreads through contact with the blood or bodily fluids of a person infected with, or who has died from, the rare Ebola strain.

It can also spread through contact with contaminated objects such as clothing, bedding, needles, and medical equipment, or through infected animals such as bats and nonhuman primates.

Historically, Bundibugyo virus outbreaks have recorded fatality rates ranging from 25 per cent to 50 per cent.

Symptoms To Watch For

Symptoms of Bundibugyo virus disease are similar to other forms of Ebola and include:

• Fever
• Headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Stomach pain
• Unexplained bleeding or bruising, usually in later stages of illness.

The ongoing Ebola virus outbreak in the Democratic Republic of Congo, which has also spread to Uganda, has been identified as caused by the rare Bundibugyo strain.

As per the US CDC, as of May 17, there are reports of 10 confirmed cases and 336 suspected cases, including 88 deaths, in DRC.

Uganda has reported 2 confirmed cases, including 1 death, among people who travelled from DRC. No further spread has been reported. These numbers are subject to change as the outbreak evolves.

Speaking exclusively to HealthandMe, Professor Emma Thomson, Director of the Centre for Virus Research (Virology) in the School of Infection and Immunity at the University of Glasgow, shared why the virus outbreak, which has been declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO), is of concern.

While the Bundibugyo virus, a member of the species Orthoebolavirus bundibugyoense, is closely related to the Ebola virus (species Orthoebolavirus zairense), it is still different and currently has no treatment or vaccine.

Professor Emma told HealthandMe that “there are several reasons for concern".

Ebola Outbreak: Likely Went Undetected For Some Time

The expert noted that "the reports that initial GeneXpert Ebola testing was negative suggest that the outbreak may have gone undetected for some time, with early diagnostic blind spots delaying recognition".

There have also been reports of infections in healthcare workers, which is "a serious warning sign in any filovirus outbreak, because they indicate unrecognized transmission in healthcare settings and gaps in infection prevention and control", the Professor said.

Notably, Ebola cases have been identified in Kinshasa and Kampala. These are "hundreds of kilometres from Ituri province, and it shows that the virus has already moved through human mobility networks before full containment was in place," Professor Emma said.

The Bundibugyo virus: Previous Outbreaks

The Bundibugyo virus has previously caused two recognized outbreaks. The first was in Bundibugyo District, Uganda, in 2007–2008, with 131 reported cases and 42 deaths, and a case fatality proportion of 34–40 per cent.

The second was in Isiro, Democratic Republic of the Congo, in 2012, with 38 laboratory-confirmed cases and 13 deaths, although wider outbreak reports, including probable and suspected cases, gave higher totals.

These figures are lower than the case fatality rates seen in many outbreaks caused by the Ebola virus, but they are still extremely serious. "Bundibugyo virus disease is not a mild infection," the expert said.

Ebola virus: Vaccine And Therapeutics

Currently, there is a licensed vaccine that targets the Ebola virus from the species Orthoebolavirus zairense (rVSV-ZEBOV).

"Experimental non-human primate work suggests that rVSV-ZEBOV may provide partial heterologous protection against Bundibugyo virus, but this cannot be assumed to translate into reliable protection in people during an outbreak," Professor Emma noted.

"Adenovirus- and MVA-vectored vaccine platforms may offer broader possibilities, particularly where multivalent constructs are used, but recent immunological data suggest that some licensed or advanced platforms still induce responses that are predominantly directed against the Ebola virus rather than broadly cross-reactive across all ebolaviruses," she added.

In other words, "we do not currently have a proven, licensed, Bundibugyo-virus-specific vaccine available for outbreak control," the Professor said, stressing the need for "urgent research" on vaccines.

Similarly, she stressed the need to boost "therapeutics" against the Ebola virus.

"Approved monoclonal antibody treatments such as Inmazeb and Ebanga were developed for the disease caused by the Ebola virus, not Bundibugyo virus, and their efficacy against other ebolaviruses has not been established," Professor Emma told HealthandMe.

"There are promising experimental broad-spectrum antibodies, but these are not yet a substitute for rapid detection, high-quality supportive care, infection prevention and control, and contact tracing," she added.

Bundibugyo-virus OutbreaK: What Should Be Prioritized?

Professor Emma further called for ramping up practical and scientifical priorities. These include:

• the Bundibugyo-virus-capable diagnostics,
• rapid genomic sequencing,
• strong infection prevention in healthcare settings,
• safe clinical pathways,
• contact tracing,
• community engagement,
• treatment centres able to deliver high-quality supportive care.

The expert also stressed the importance of genomic sequencing as it can:

• confirm the virus species,
• Identify whether cases are linked,
• reconstruct transmission chains,
• Detect whether the outbreak reflects sustained human-to-human transmission or multiple introductions.

“This outbreak also highlights a persistent weakness in epidemic preparedness. We tend to build tools around the best-known outbreak pathogens, but rarer viruses such as Bundibugyo virus can still cause severe disease and international spread," Professor Emma said.

The expert also highlighted the essential need for

• sustained investment in high-containment laboratories,
• diagnostic development,
• genomic surveillance,
• vaccine platforms,
• therapeutics and international research partnerships.