Matthew Perry Died from “Acute Effects of Ketamine” according to his autopsy report. Many of us have read with deep concern of the death of the 54-year-old Hollywood star and wondered what this tragedy tells us about the safety of ketamine treatment. As the medical director of a ketamine clinic in Colorado who has treated […] The post Matthew Perry’s Death: Ketamine Safety Concerns Explained appeared first on Colorado Ketamine.

Matthew Perry Died from “Acute Effects of Ketamine” according to his autopsy report.

Many of us have read with deep concern of the death of the 54-year-old Hollywood star and wondered what this tragedy tells us about the safety of ketamine treatment. As the medical director of a ketamine clinic in Colorado who has treated over 700 patients with high levels of success, I have been receiving many questions about the safety of ketamine as a psychiatric treatment. Here are my observations.

Matthew Perry played Chandler Bing on the successful television show “Friends”. In real life, Matthew Perry was all too human. He began drinking alcohol at age 14 and described becoming addicted to it at age 18. He reported in his biography that he had 65 admissions for detox from alcohol, was admitted 15 times for longer alcohol rehab treatments, and had attended 6,000 AA meetings to curb his addiction. In addition, following a jet ski accident in 1996, he became cross-addicted to opiate pain killers and struggled with this addiction for the next 16 years.

Perry first sought ketamine treatment for depression at a ketamine clinic, whose staff saw that his depression and anxiety improved and then completed treatment. It is unclear if they recognized or even had the opportunity to see the extent of the addiction that then took over. Perry then fell into the hands of a group of individuals who peddled ketamine and, as text messages have revealed, figured out how to fleece him for money by suppling ketamine. He used his own personal assistant to inject him in his home. He ultimately died after a third dose of ketamine in a single day. His assistant then left him alone where he was later found face down in his hot tub, having drowned. Five people have been arrested for alleged illegal activities related to Perry’s death including two physicians. As many have noted, there are similarities between Perry’s end-of-life journey and that of Michael Jackson.

Among the facts about Mr. Perry that I have been able to learn are the following.

Amount of ketamine:

• He took very large amounts of ketamine. In the 29 days prior to his death, he reportedly spent $55,000 on ketamine, an astronomical sum indicating use of massive amounts of ketamine.
• His blood level at autopsy was 3,540 ng/ml, a level roughly 24 times higher than that experienced with normal ketamine IV treatment.
• He also had ketamine in his stomach which means he also was taking it orally or nasally.

He mixed ketamine with multiple other drugs:

• The autopsy report shows he had therapeutic amounts of buprenorphine (an opiate blocker which has opiate activity) and two benzodiazepines (lorazepam and clonazepam). Each of the drugs in his system are individually capable leading to loss of breathing. The combination of all four is extremely dangerous.

He had other serious health problems at the time of his death which should have ruled out the use of this combination of drugs

• Chronic Obstructive Pulmonary Disease (COPD) with emphysema.
• Moderate to severe coronary artery disease.
• Liver damage.
• His pancreas was severely fibrosed and calcified, and he had Diabetes Type II.
• His kidneys were severely scarred with loss of functioning.

The easiest thing would be to write this sad story off as so extreme as to not have much relevance to the usual administration of ketamine in a medical office. But that would be short sighted. Any drug, especially a drug with a history of street misuse, can be a real problem. All involved, doctors and patients, need to be careful. After all, Perry’s ketamine addiction began with legitimate use of the medication, just as his opiate addiction had begun the same way. That is one of the cautions. Certain people exposed to legitimate use of mediations can become addicted. That is the story for the epidemic of the opiate addiction in the USA… and so too for some ketamine addicts. Anyone who is experiencing addiction needs to be very careful about beginning the use of pain killers or ketamine.

Key facts about Ketamine IV Therapy:

1. Medical literature supports the observation that ketamine IV Infusions help between 60% to 70% of those with treatment resistant depression get better. Traditional antidepressants are not effective in about 1/3 of patients who try them and by the fourth trial significantly help only 9% of patients. Ketamine is a critical tool to use in addressing depression.
2. Ketamine targets the glutamate system of the brain. Traditional antidepressants do not interact with glutamate. Glutamate-acting antidepressants offer hope for patients where other drugs do not.
3. Ketamine is very rapidly acting: often helping reduce depression and suicidal ideation within one to two days. Traditional antidepressants take on average 3 to 6 weeks to begin to work.
4. A recent review of ketamine IV use by 3,756 patients in psychiatric settings showed serious adverse events happened in a total of four patients (0.1% of the cases), with no deaths. [Hovda N et al, DOI: 10.1016/j.jad.2023.10.120]. This is an extraordinarily low rate of serious side effects for any medication.
5. Ketamine as a treatment of depression was first studied and developed at the National Institute of Health, not a pharmaceutical company, in 2006. The medical literature is extensive. The National Library of Medicine’s PubMed reports 524 articles have been published on the topic of ketamine and depression alone, with 5,192 articles on ketamine’s uses and safety in medicine.
6. The use of ketamine for psychiatric purposes is “off-label” (meaning not FDA reviewed). Such use is legal once a drug has been approved for other purposes (in this case for anesthesia). It is reported that up to 46% of all medications prescribed in the USA are prescribed “off-label” depending on the class of medication.
7. For a drug to be “on label,” a pharmacy company must submit studies of the use of the drug to the FDA for review. As ketamine is generic and no company can market it exclusively, it is a likely consequence of government’s own rules that no drug company has been willing to prepare and submit a study as they would get no financial benefit from such a study.
8. Ketamine IV treatment for depression is recommended at a dose of 0.25 mg per pound of body weight which translates into average dose of 50 mg per dose. Research shows that doses above approximately 125 mg do not help with depression and instead only cause psychedelic experiences. Mr. Perry had taken approximately a 1,200 mg dose on his last injection.
9. Taking ketamine in your home is very risky, especially with no real medical oversight. The internet delivers advertisements from companies who offer ketamine to be used at home. This is medically very unwise and risky. Proper medical oversight is essential to distinguish anti-depressant from psychedelic use. The FDA has held public hearings about this at home practice and may enact regulations to limit this activity.
10. When using ketamine for psychiatric purposes it is important to seek out a well-trained psychiatrist who follows the ethics and standards of the American Psychiatric Association and the American Society of Ketamine Providers-3, the professional organization to which most reputable providers of ketamine belong. One should consider carefully the provider’s overall medical qualifications, his or her experience with ketamine treatment, and their knowledge and training in addiction medicine. Being a doctor who has provided ketamine in combat medicine, or in the operating room, or in the emergency room is not the same as having experience in its use in psychiatric medicine. The drug is the same but knowing how to help the patient get better using it is entirely different than knowing how to use ketamine.

The death of Mr. Perry reminds us that good things can go horribly wrong, especially when there are unscrupulous or self-serving individuals willing to profit from someone’s distress. Some of these sadly have been physicians.

My staff and I have been providing IV ketamine services since 2014. I am a board-certified psychiatrist, with experience in psychiatry and addiction medicine, a Distinguished Life Fellow of the American Psychiatric Association, and have 47 years’ experience in this field. Consider your options carefully. But above all discuss your entire history with your doctor, make certain you understand the benefits and the risks of any treatment, and discuss any side-effects you develop. No one should have to live with treatment resistant depression. Especially when we can help up to 70% of those get better. You do need to consider all available options, but do not embark on a needed treatment without high quality medical supervision.

I welcome any questions.

Dr. John L Fleming, MD, DLFAPA, FCTMSS, MASKP3
Colorado Ketamine Clinic
Email: [email protected]
Web: https://colospringsketamine.com/
Phone: 719-471-7206

The opinions in this paper are those of Dr. Fleming. All rights are reserved.

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