Matthew Perry’s death offers a tragic lesson about ketamine
Medical examiners last Friday released a lengthy autopsy report that identified ketamine as the cause of death for “Friends” actor Matthew Perry, who was found unresponsive in his pool in late October.
The 54-year-old’s tragic death places a spotlight on ketamine and offers a key lesson about the substance: Yes, ketamine can be safe and highly effective when used medically under careful supervision, but it can also be dangerous — even fatal — when used recreationally and without necessary safeguards.
Safe when used safely
The Food and Drug Administration approved ketamine for use as a general anesthetic in 1970. It remains the medication of choice in many surgeries and is on the World Health Organization’s list of essential medicines because of its record of safety, efficacy and cost-effectiveness.
For at least two decades, ketamine has also been used to treat patients with severe depression that is unresponsive to conventional therapies. This practice is considered “off-label” because the FDA has not approved ketamine for any psychiatric condition, but physicians are able to prescribe the drug if they deem the benefits outweigh the risks.
In recent years, infusion clinics offering intravenous ketamine doses have sprung up across the United States. They purport to treat a wide range of conditions, from depression to post-traumatic stress disorder to bipolar disorder. Some patients swear by these treatments, reporting near-immediate relief from disabling symptoms, and some studies back up these anecdotes. Such treatments also appear to be safe; a 2023 review found no cases of overdose or death related to ketamine use in therapeutic settings.
Perry’s autopsy report indicates the actor was receiving regular ketamine infusions to treat mental health ailments, but his last infusion was a week and a half before his death. This would not explain the level of ketamine in his blood at the time of death, which was in the range of someone undergoing general anesthesia. The half-life of intravenous ketamine is a few hours, meaning the ketamine administered during his therapy would have been long gone.
It’s possible that Perry obtained ketamine through some other means for recreational use or self-medication. Both are dangerous and should be further restricted.
FDA concerns
Ketamine is similar to phencyclidine, or PCP. Both drugs can increase heart rates and blood pressure, posing risks for people with cardiovascular disease. They can also induce visual and auditory hallucinations and a sensation of being detached from one’s body and surroundings. In high amounts, ketamine can lead to sleepiness, seizures and death.
The Drug Enforcement Administration reports that illegal ketamine, often referred to as “special K” or “vitamin K,” is frequently distributed at nightclubs, raves and private parties, where the drug is crushed into powder and inhaled. Overdoses can be fatal, especially if the supply is contaminated with the potent opioid fentanyl.
Ketamine is also available legally as a pill through a process known as compounding, whereby pharmacists can formulate a new version of a medication that is not inspected by the FDA for quality or safety. During the pandemic, the use of compounded ketamine skyrocketed as new telemedicine provisions allowed this drug to be prescribed over the internet.
The FDA has been so alarmed by this trend that it has issued two alerts. Not only did it bring up safety concerns over compounded products, but it also cautioned that the “the lack of monitoring for adverse events, such as sedation and dissociation, by an onsite health care provider may put patients at risk.”
Indeed, patients using ketamine in medical settings are closely monitored during treatment. Upon discharge, they are instructed not to drive because of grogginess and impaired judgment. Individuals using ketamine at home are at risk of these same side effects but might not implement the same guardrails.
Follow the rules
This could have been the case with Perry. The autopsy revealed ketamine in his stomach, suggesting he consumed the drug orally in pill form. It was not safe for him to be in a body of water by himself.
That could be one takeaway from this tragic episode: Individuals taking ketamine and other mind-altering substances should not use them alone. Another is the same cautionary tale from psilocybin and other psychedelic medicines: Just because a substance has legitimate medical purposes doesn’t mean that it’s safe for individuals to consume as a party drug or as unmonitored self-treatment.
And conversely, just because ketamine was the culprit in Perry’s devastating death doesn’t mean that patients who would benefit from it should shy away. Ketamine, just like other highrisk drugs, must be approached with caution and rigorous adherence to therapeutic protocol.