Here’s What You Need to Know About Ketamine, the Drug Linked to Matthew Perry’s Death
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An autopsy report determined that Matthew Perry died of the acute effects of ketamine.
The Friends star was found unresponsive in a hot tub in his home in October.
Ketamine is often used for anesthesia and to treat depression.
A cause of death has been determined for Matthew Perry, months after the Friends star was found unresponsive in a hot tub at his home. Perry died due to the acute effects of ketamine, according to the autopsy report.
The report notes that drowning, coronary artery disease, and effects from buprenorphine, a medication used to treat opioid use disorder, were also listed as contributing factors to the 54-year-old’s death. Perry’s death was also ruled accidental.
While the report noted that Perry had been taking ketamine infusion therapy, it also said that the ketamine in his system could not have been from his last therapy session, which was a week and a half before his death. The report also said that the level of ketamine found in Perry’s blood was equivalent to the amount that would be used for general anesthesia.
Perry wrote about undergoing ketamine therapy in his 2022 book, Friends, Lovers, and the Big Terrible Thing: A Memoir. “‘Oh,’ I thought, ‘This is what happens when you die,’” he wrote, per the Daily Beast. “Yet I would continually sign up for this shit because it was something different, and anything different is good.” Perry eventually concluded that “ketamine is not for me” because “taking K is like being hit in the head with a giant happy shovel.” He also said that the “hangover was rough and outweighed the shovel.”
The report has raised a lot of questions about ketamine, ketamine effects, and whether the drug is legal. Here’s what you need to know about ketamine.
What is ketamine and is it legal?
Ketamine is a dissociative anesthetic that has some hallucinogenic effects, according to the Drug Enforcement Association (DEA). Meaning, it distorts some perceptions of sight and sound and makes people feel disconnected from reality.
“Ketamine works centrally in the brain,” says Jamie Alan, Ph.D., Pharm.D., an associate professor of pharmacology and toxicology at Michigan State University. “It works through receptors in the brain to send signals to the heart.” It also can work in the brain to cause pain relief and lowers heart rate and blood pressure, Alan says.
Ketamine is a Schedule III controlled substance, and it’s legal when it’s dispensed by a licensed professional, Alan says. “It’s always legal. It’s a question of whether or not it’s used for an indicated purpose, like when a doctor prescribes it,” says Edward Boyer, M.D., Ph.D., an emergency medicine physician specializing in medical toxicology with The Ohio State University Wexner Medical Center.
“Ketamine also comes in a street drug form where it is used for drug abuse—this is not legal,” says Gail Saltz, M.D., clinical associate professor of psychiatry The New York Presbyterian Hospital and host of the “How Can I Help?” podcast.
What are ketamine effects?
Ketamine makes people feel like their mind and body are separate, Dr. Boyer explains. “People who use it who aren’t using an anesthetic dose will clump around because they can’t feel their feet,” he says. “If you use an anesthetic dose, you don’t recognize what’s going on.”
Ketamine can make people feel detached from their pain and environment, the DEA notes. It can also cause these effects:
Feelings of sedation
Immobility
Pain relief
Amnesia (i.e. no memory of what happened while using the drug)
“People describe feeling near death-like experiences where they feel like they go in a hole and have visual and auditory hallucinations,” Dr. Saltz says.
How is ketamine used?
Ketamine is used to treat pain, in intensive care settings, in procedural sedation, and for palliative care. “It is often used for short term anesthesia—think: Setting a broken bone in the ER—and for depression,” Alan says.
“You can administer it any one of a few different ways—intravenously, an intramuscular injection, and intra-nasally,” Dr. Boyer says.
But ketamine is sometimes misused, Alan points out. In those cases, it’s often called by the street name “Special K,” per the DEA.
Effects of mixing ketamine with other drugs
Ketamine can be concerning if it’s mixed with other drugs, Alan says. “When ketamine is mixed with things like alcohol and opioids, it can make the effects of these drugs greater,” she says. “Meaning, the person combining these medications may be more likely to suffer adverse consequences such as respiratory arrest.” Someone may also feel nauseous, vomit, and pass out, she says.
“Most of the issue with ketamine isn’t mixing it with other drugs—it’s the rate at which it’s administered,” Dr. Boyer says. If the drug is given to fast, it can cause someone to breathe too shallowly or too slowly, he says.
Can ketamine be lethal?
Yes, ketamine can be lethal. “The concentration of ketamine found in Matthew Perry’s blood was sufficient to cause loss of consciousness and lack of responsiveness to external stimulation,” says Lewis Nelson, M.D., chair of the department of emergency medicine and chief of the division of medical toxicology at Rutgers New Jersey Medical School. This, Dr. Nelson says, explains why Perry went underwater and didn’t wake up.
“Ketamine does not generally cause death from cardiac or respiratory effects, but rather from associated injury,” Dr. Nelson says. Alan agrees. “Ketamine on its own is rarely lethal,” she says.
Dr. Boyer says the main issue with ketamine in the setting where it’s used, given that people disassociate from reality. “If you use an anesthetic dose, you don’t recognize what’s going on,” he says. “If you use it in a pool or hot tub, you could potentially drown.”
Dr. Saltz underscores the safety of ketamine when used in a clinical setting. “It is important for people to understand that IV ketamine infusions are a safe and oftentimes effective treatment for people who have severe depression and have not responded to multiple other treatments and remain at risk for inability to function in life, as well as death by suicide,” Dr. Saltz says.
Dr. Boyer stresses that Perry didn’t die of ketamine poisoning, noting, “he used ketamine, and then he drowned.”
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