An autopsy report released Friday by the Los Angeles County coroner said the death of “Friends” actor Matthew Perry, who was found face down and unresponsive in a hot tub at his home on Oct. 28, was due to the “acute effects”. of ketamine, an anesthetic with psychedelic properties.
Ketamine is becoming increasingly popular as a treatment for treatment-resistant depression and other mental health problems. It is also used in leisure time.
Mr. Perry had publicly acknowledged that he had long struggled with alcohol and drug use, but the report said he had been sober for 19 months and little was known about his relationship with ketamine.
What is Ketamine and is it legal?
Ketamine is an injectable, short-acting dissociative anesthetic that can cause hallucinogenic effects in certain doses. It distorts the perception of images and sounds and causes the user to feel detached from the pain and their surroundings.
Ketamine was developed in the 1960s as a battlefield anesthetic and has been legal for use on humans and animals since 1970. It is commonly used as an anesthetic for children, especially in developing countries.
However, psychiatric use of ketamine is still unapproved and unregulated, although it is increasingly used off-label to treat depression, suicidal ideation and chronic pain.
In 2019, the Food and Drug Administration approved a ketamine derivative called esketamine in a nasal spray to treat treatment-resistant depression.
Ketamine carries the potential for abuse that can result in moderate or low physical dependence or high psychological dependence, but experts consider it a safe drug.
Those who use it recreationally often snort the drug in powder form or administer it intranasally as a spray.
“People should not be afraid to use ketamine if it is prescribed by their doctor and administered correctly in a healthcare setting,” said Dr. Gerard Sanacora, director of the Yale Depression Research Program and co-director of the Yale New Haven Hospital Interventional Psychiatry Service.
Can Ketamine Be Deadly?
According to the Drug Enforcement Administration, ketamine is rarely fatal, but an overdose can cause unconsciousness and dangerously slow breathing. The amount of ketamine found in Mr. Perry's body was extremely high, comparable to an anesthetic dose, the coroner's office wrote.
Side effects such as increased blood pressure and paranoia are rare and typically occur at very high doses. Bladder problems may occur if the drug is consumed frequently.
The FDA issued a warning in October about the dangers of using compounded versions of ketamine. Compound medicines are medicines that have been modified or adjusted in the laboratory to meet the specific needs of an individual patient.
The agency, citing reports of adverse events, warned that unsupervised use of compounded ketamine increases the risk of dangerous psychiatric reactions and health problems such as elevated blood pressure, respiratory depression and urinary tract problems that can lead to incontinence.
The autopsy report found that Matthew Perry had more ketamine in his body than is needed for a typical infusion. Photo credit: Carlo Allegri/Portal
Dr. Steven Radowitz, chief medical officer at Nushama, a ketamine clinic in New York, said patients must pass a comprehensive medical and psychiatric evaluation “to ensure they are appropriate for treatment.”
At Nushama and other clinics, doses are administered in “subanesthetic” amounts to keep patients conscious during their therapy sessions, Dr. Radowitz.
What is known about Mr. Perry's ketamine use?
Mr. Perry had been undergoing medically supervised ketamine infusion therapy for depression and anxiety and had received an infusion a week and a half before his death, according to the autopsy report. The medical examiner's office determined that the treatment had no connection to his death because the drug only remains in the body for a few hours.
Although not mentioned in the report, it suggests that Mr. Perry was using ketamine at home at the time of his death.
Law enforcement did not find ketamine in his home, the coroner said.
The report did not detail the exact sequence of events that led to Mr. Perry's death, but cited three contributing factors: drowning, coronary artery disease and buprenorphine, a prescribed medication he was taking to treat his opioid addiction .
“Given the high levels of ketamine found in his postmortem blood samples, the fatal consequences would be primarily cardiovascular hyperstimulation and respiratory depression,” the report said.
In high doses, ketamine can cause dangerous changes in blood pressure that can be particularly harmful to people with cardiovascular disease.
The sedative effects of ketamine may be enhanced by the buprenorphine that Mr. Perry was taking.
Dr. Sanacora of Yale University said the plethora of risk factors made it difficult to determine exactly what caused Mr. Perry's death.
“I'm not a coroner or a forensic pathologist, but he had a lot of risk factors and there are a lot of possible things that could happen,” he said. “The most important takeaway is that ketamine is not a drug that you take at home.”