“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.

The United States shelved the decision to vaccinate poultry as a bird flu prevention measure due to HHS Secretary Robert F. Kennedy Jr.’s skeptical vaccine views

According to a Politico report, the move came as highly pathogenic avian influenza, especially the H5N1 strain, continues to affect poultry farms, threatening bird populations, disrupting egg supplies and raising concerns about transmission to humans.

According to Politico's findings, five people who were involved in the decision-making said that Agriculture Secretary Brooke Rollins pulled back an internal strategy for vaccinating poultry and hens that lay eggs.

The plan was initially intended to be shared with governments of other countries, industry leaders and other stakeholders to help boost bird flu response.

However, it remains unclear whether Kennedy directly asked Rollins to halt the strategy. However, concerns about how poultry vaccination would be received by the health secretary reportedly influenced the decision to keep the document away from wider circulation.

Why Was The Poultry Vaccination Plan Shelved?

Also read: Pope Leo XIV’s Lung Cancer Diagnosis: When Should You Worry About Lung Nodules?

The US Department of Agriculture (USDA) announced a $1 billion bird flu response strategy in February 2025. The plan included $500 million for farm biosecurity, $400 million in financial relief for farmers and $100 million for vaccine research.

Despite the resources, an internal poultry vaccination strategy reportedly failed to be executed as planned. One person familiar with the process told Politico that the technical and communication components were already in place by the summer of 2025, but the final document was circulated among fewer than a dozen people.

Kennedy has publicly opposed vaccinating poultry against bird flu, arguing that vaccines that do not completely prevent infection could allow the virus to continue evolving.

In a March 2025 interview with Fox News host Sean Hannity, Kennedy warned that using vaccines that do not provide complete protection could turn poultry flocks into “mutation factories”.

He argued that allowing the virus to circulate among birds could help identify animals with natural immunity. The proposal attracted criticism from veterinary and vaccine experts, who warned that permitting uncontrolled infections could, in turn, increase viral replication and create opportunities for mutations.

Dr Gail Hansen, a former state veterinarian for Kansas, criticised the idea of allowing bird flu to spread through poultry populations, calling it a “really terrible idea, for any one of a number of reasons”. She warned that a virus circulating through a flock containing millions of birds would have many opportunities to evolve or mutate, which increases the risk to other animals and farm workers.

Also read: US Health Secretary Wants To Expand Vaccine Injury Reporting: Benefits And Risks Explained

Can Vaccinating Poultry Help Control Bird Flu?

Vaccination is one the effective tools for reducing bird flu infections and containing transmission. However, vaccines do not always provide sterilising immunity, meaning vaccinated animals may still become infected even if they are protected against severe disease.

So, if vaccination reduces visible symptoms without fully preventing infection, infected birds may be harder to identify unless monitoring systems are efficient.

However, this does not mean vaccination inevitably creates dangerous mutations. The evolution of viruses occur naturally, and vaccination can reduce the number of opportunities for viral replication. The overall effect depends on the vaccine effectiveness, surveillance, biosecurity and how the nature of the virus.

Countries including France, China, Egypt and Mexico have used poultry vaccination against avian influenza. In the US, the USDA granted conditional approval for an avian influenza vaccine in 2025, but poultry vaccination has not been adopted yet.

H5N1 has infected people following exposure to infected animals, but sustained human-to-human transmission has not been established yet. Hence, preventing infections in poultry remains important for reducing opportunities for the virus to spread and evolve.

The Keralam government has introduced the Keralam Senior Citizens (Care and Protection of Rights) Bill, 2026, to regulate elderly-care facilities and services. It proposes mandatory registration of care centers and caregivers, prescribed standards, caregiver certification, and penalties for violations.

Referred to the Assembly’s subject committee, the Bill would establish a legal framework for elderly care if passed.

Keralam introduced its first elderly-care policy in 2006, updated it in 2013, and released a draft State Policy for Elder Persons in August 2025. The state also enacted the Kerala State Senior Citizens Commission Act, 2025, and has a dedicated department for senior citizens’ welfare.

Why Does Keralam Need The Bill?

Also read: Healthy Lifestyle Changes Improve Memory, Thinking In Older Adults At Dementia Risk: The Lancet

Chief Minister V. D. Satheesan introduced the Bill, expressing confidence that it would make Kerala a model for elderly care.

“Nobody should feel that they are alone or abandoned. The way a society treats its elderly determines how civilized it is,” he said.

Keralam has one of India’s largest elderly populations, partly due to its high life expectancy. Older adults are projected to account for 22.8% of the state’s population over the next decade, up from 18.7%, highlighting the growing need for care services.

What Does The Bill Propose?

• Dignity and care: Promotes ageing in place, home-based care, safety, and social inclusion.
• Access and rights: Seeks better access to healthcare, legal aid, safe public spaces, digital inclusion, and abuse-reporting mechanisms.
• Protection units: Proposes state and district-level bodies to monitor care services and address complaints.
• Care-centre regulation: Requires registration of senior citizen care centres and sets service standards.
• Caregiver certification: Proposes training, phased certification, a Keralam Geriatric Care Certification Framework, and a state register of caregivers.
• Cybercrime safeguards: Proposes a Senior Citizen Cyber Fraud Cell at every cyber police station.
• Welfare funding: Calls for a state reserve fund for care, protection, welfare, and social security.
• Penalties: Provides for punishment for violations of the proposed law and related rules.

Why Elderly Care Needs A Broader Approach

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Speaking to HealthandMe, Dr. Rajeev Jayadevan, Ex-President of IMA Cochin and Convener of the Research Cell, Kerala, said the principles outlined in the Bill could eventually apply across India, particularly as Keralam has a higher proportion of older adults than many other states.

With shrinking nuclear families and urbanization, fewer family members may be available to provide full-time care, increasing reliance on state-supported services, including home care, medical consultations, and palliative care.

He emphasized that older adults have distinct care needs and highlighted patient autonomy in end-of-life decisions. Living wills allow people to document their medical-care preferences in advance, helping families and healthcare professionals understand their wishes and potentially avoid unwanted interventions.

Dr. Rajeev also stressed the need for trained, certified caregivers, effective oversight of care providers, and safeguards against elder abuse.

As older adults increasingly use digital platforms for services such as banking, digital literacy and protection against online scams and financial fraud are also essential, he noted.

What Are The Health Challenges Facing Older Adults?

READ: Normal Ageing or Alzheimer's? Doctors Explain Six Key Differences to Watch For

India’s senior citizen population is projected to reach around 230 million by 2036, or approximately 15% of the population. Southern states, along with Himachal Pradesh and Punjab, have larger elderly populations, with regional disparities expected to widen.

Moody’s Ratings said in September that India’s population is expected to age significantly as fertility falls below replacement levels.

Older adults often face chronic conditions such as diabetes, high blood pressure, and high cholesterol, alongside complications including diabetic kidney disease, diabetic retinopathy, cataracts, and glaucoma. These health needs underscore the importance of accessible, coordinated long-term care.

CVS Pharmacy and its subsidiaries have agreed to pay $315 million to settle a US Department of Justice lawsuit alleging that the pharmacy chain unlawfully dispensed opioid prescriptions that were not needed medically.

The settlement, announced on October 13, also requires the company to implement safeguards against inappropriate and unnecessary dispensing.

Filed in December 2024, the lawsuit alleged that CVS dispensed prescriptions that lacked a legitimate medical purpose, involved excessive quantities of opioids or were dispensed too early.

The government also alleged that the company filled prescriptions from so-called “pill mills”, suppliers who are accused of issuing large numbers of controlled-substance prescriptions without a legitimate medical purpose. CVS has strongly disputed the allegations and denies any wrongdoing as part of the settlement. The agreement resolves the civil claims without a determination of liability.

Unsafe Opioid Prescriptions Can Increase Addiction Risk

Also read: Why Is The US Fast Tracking Trials Of Ibogaine, A Schedule I Controlled Substance, Despite Safety Risks

Opioids are powerful medications used to treat moderate to severe pain. They include prescription drugs like oxycodone, hydrocodone and morphine.

When prescribed appropriately and taken under medical supervision, they can provide important relief. However, their effects on the brain'can also lead to dependence and addiction issues.

Dependence and addiction are related but different. Physical dependence occurs when the body adapts to a medication. If stopped abruptly, one may experience severe withdrawal symptoms.

Opioid use disorder, commonly referred to as opioid addiction, involves a destructive pattern that can include cravings, loss of control and continued use despite harmful consequences.

The risk increases when these opioids are prescribed or taken in excessive doses or combined with other similar medicines. Taking more than prescribed can also increase the risk of overdose, which can slow or stop breathing and may be fatal.

The Justice Department's lawsuit alleged that CVS dispensed prescriptions for dangerous combinations of medicines, including “trinity” prescriptions combining an opioid, a benzodiazepine and a muscle relaxant. Such combinations can lead to a compounded sedation effect and respiratory depression, increasing the risk of serious harm.

In these cases, addiction becomes more than just a habit. These substances alter brain chemistry, particularly in the areas related to reward, motivation, and self-control. Hence, recovery is not simply about choosing to quit.

Addiction hijacks the brain’s prefrontal cortex—the area responsible for decision-making, self-control, and judgment. As a result, people suffering from addiction are often unable to regulate their behavior, even when they want to.

The brain’s reward system reinforces substance use by releasing dopamine, the chemical associated with pleasure and reward. Over time, the brain becomes dependent on this chemical surge, leading to tolerance (needing more of the substance to feel the same effect) and withdrawal symptoms when the substance is not available.

Also read: ‘Zombie’ Drug Medetomidine, Spotted In Heroin Supply, Raises Concern As It Could Evade Overdose Antidote

What Did The Lawsuit Allege?

According to the Justice Department, the alleged dispensing practices occurred between October 2013 and December 2025. The government claimed that staffing shortages, performance targets and incentive policies contributed to pharmacists filling prescriptions without adequately checking whether they were legitimate.

Many of the prescriptions were allegedly billed to federal healthcare programmes, including Medicare and Medicaid, prompting claims under the federal False Claims Act as well as the Controlled Substances Act.

“Today's settlement is a significant milestone in the Justice Department's efforts to combat the opioid epidemic by cracking down on pharmacies who unlawfully fulfill prescriptions for controlled substances,” Associate Attorney General Stanley Woodward said in a statement.

CVS said its pharmacists were trained “in the safe and appropriate use of all medications” and that the company had introduced programmes to help them make appropriate decisions for patients.