Nearly three years after actor Matthew Perry’s tragic death from ketamine, five people who contributed to the “Friends” star’s death have been convicted.
They included his dealer who was known as “the ketamine queen” and a personal assistant who injected Perry with what turned out to be the fatal doses of ketamine.
The criminal penalties and prison sentences in Perry’s death are once again raising questions about how medical experts and people struggling with depression are using ketamine and whether the anesthetic and psychedelic drug is safe.
Perry was best known for playing the fast-talking, wickedly funny Chandler Bing on “Friends.”
Authorities said multiple people contributed to Perry’s death, highlighting the dangers of improper use of ketamine at a time when there’s also growing interest in the drug as a treatment for depression.
Ketamine also was to blame for the death of Elijah McClain, an unarmed Black man, who was stopped by police while he was walking in Aurora.
To understand more about ketamine, how it works and when doctors use it to help with depression in supervised settings, we consulted with Dr. Pat Fehling, a psychiatrist and addiction medicine specialist at the UCHealth Center for Dependency, Addiction and Rehabilitation (CeDAR).
Fehling is also an associate clinical professor in the Department of Psychiatry at the University of Colorado Anschutz School of Medicine.
How did ketamine contribute to Matthew Perry’s death?
Medical examiners in Los Angeles County determined that Perry died accidentally on Oct. 28, 2023 from the “acute effects of ketamine” while in the heated end of his swimming pool. They found levels of ketamine in Perry’s system similar to those used during general anesthesia.
Court records later revealed that Perry had been receiving ketamine both through supervised treatments and from illegal drug dealers in the weeks leading up to his death, according to a U.S. Drug Enforcement Administration press release. Prosecutors said his live-in assistant obtained dozens of vials of ketamine from multiple sources and repeatedly injected Perry, including on the day he died.
Perry had been using ketamine in a supervised setting to cope with depression and recovery from decades of addiction struggles, which Perry chronicled in his book, “Friends, Lovers, and the Big Terrible Thing.” But, according to the medical examiner, Perry’s last supervised treatment had taken place more than a week before his death, and the drug typically leaves the body within hours.
That finding indicated that the ketamine in his system at the time of his death came from a more recent dose. The medical examiner reported that the ketamine caused cardiovascular “overstimulation and respiratory depression,” which likely led Perry to lose consciousness in the water.
“Contributing factors in Mr. Perry’s death include drowning, coronary artery disease and the effects of buprenophrine (used to treat opioid use disorder),” medical examiners wrote.
Perry’s case underscores how ketamine’s effects can vary widely depending on how, when and why people use it.
What is ketamine? And why are people using it to deal with depression and trauma?
Ketamine is a drug that dates back to the 1960s and has been used for years as a powerful anesthetic.
Fehling said emergency responders sometimes use ketamine because it’s generally safe, fast-acting and the effects of ketamine wear off relatively quickly.
“For instance, if you get injured skiing, and you break your leg, ski patrol responders almost certainly would give you ketamine. People get a little loopy, but ketamine provides good pain relief and generally protects a person’s breathing,” Fehling said.
Over the past 10 years, ketamine has gained traction as both a recreational drug and for people seeking treatment from depression or post-traumatic stress disorder.
Is ketamine approved for the treatment of depression by the U.S. Food and Drug Administration (FDA)?
A variant of the ketamine molecule received FDA approval in 2019 for people with treatment-resistant depression and suicidal thinking, Fehling said.
This version of ketamine is called “esketamine.” The brand name is Spravato.
The drug is a nasal spray and requires supervision by a medical expert since people with a history of heart problems can be at risk when they use the drug, and patients using ketamine can have dissociative experiences.
“It’s the only FDA-approved ketamine-derived treatment that is authorized for behavioral health purposes,” Fehling said. “The other forms of ketamine are approved for emergency care and intensive care.”
Who qualifies for esketamine treatments?
The drug is approved for people with treatment-resistant depression, meaning they have not responded to at least two antidepressant medications, as well as for some patients with major depression and acute suicidal thinking. They must receive treatments in a doctor’s office or a certified clinic under medical supervision.
Does ketamine work for depression?
Yes. When used in safe, supervised settings with a medical expert, ketamine seems to help some people who have treatment-resistant depression, Fehling said.
But ongoing research is vital. It’s not clear how long ketamine works, how many treatments people need and who the best candidates are.
It can also cause scary experiences for some users.
Despite the challenges of ketamine, Fehling said medical experts welcome new therapies to help people who are coping with depression and have not responded to antidepressants.
“We have very few options for treatment-resistant depression,” Fehling said. “This is one option. Another is electroconvulsive therapy or ECT. It involves anesthesia in a medical setting. It has very strong response rates but also has strong side effects.”
Ketamine, in contrast, does not require surgery or anesthesia, and medical experts view it as much less invasive than ECT.
What are the negative side effects or potential risks of using ketamine?
Ketamine can elevate blood pressure, and there have been some high-profile deaths related to ketamine, like those of Perry and McClain.
“Blood pressure surges with ketamine, and that can set off cardiac arrest,” Fehling said. “There have been other deaths related to drowning while a person is dissociating.”
How do most people respond to ketamine? If you take ketamine, what does it feel like?
“Ketamine tends to make people feel very woozy. It can lead to nausea. Many people have very surreal, dissociative experiences while they are going through ketamine treatments,” Fehling said.
That’s why it’s essential to have medical supervision, and it’s very unsafe to be in water where you could lose awareness of where you are and drown.
Fehling does not administer ketamine at CeDAR, but said it can be valuable for patients who are dealing with addiction and depression.
UCHealth has three behavioral health specialty clinics that offer esketamine, along with ECT and transcranial magnetic stimulation (TMS) as treatment options for major depressive disorder, bipolar disorder and other complex behavioral health diagnoses.
During supervised treatments, medical experts actively monitor patients’ blood pressure to ensure that they are safe.
Patients also cannot drive themselves home after treatment since the effects of ketamine can be strong and can last for a few hours.
Is unsupervised ketamine use safe?
No. It’s best for patients to work closely with trusted medical providers.
“Any use of ketamine needs to involve thoughtful, evidence-based collaboration with a medical professional,” Fehling said. “There are plenty of opportunities to get the FDA-approved esketamine or the generic ketamine in clinics where the drug can help resolve depression.”
Reputable clinics that offer ketamine must abide by stringent safety guidelines.
“There are very high standards that have to be met. The medical experts need to have a ‘crash cart’ available to revive a person who stops breathing or has a cardiac issue. None of that is going to be available for people who are using ketamine in their own spaces,” Fehling said.
How long does ketamine last?
The dissociative effects of ketamine usually last a few hours. That’s much shorter than the effects of other psychedelic drugs like LSD and psilocybin.
Are there other names for ketamine?
Yes. The drug has many street names, including Special K, Vitamin K and Kit Kat. People who trip on ketamine recreationally often say they’ve had a “K-hole” experience.
Who is at the greatest risk of suffering negative side effects or death with ketamine? Is ketamine addictive?
Yes. Ketamine can be addictive. In addition to being dangerous for people with high blood pressure or other heart problems, ketamine can become addictive for people who have a history of addiction to other substances, like alcohol and other drugs, Fehling said.
“It’s vital to pay close attention to whether a person has a prior substance use disorder since there are some addictive qualities to this drug,” he said. “It lends itself to addiction. It acts quickly, and it’s strong.”
What does the scientific evidence show about ketamine? How long do people need to use it?
“The scientific literature related to the resolution of depression is complex. People need a series of treatments about two times a week for a number of months,” Fehling said. “Ketamine seems to have robust effects. It can reboot the brain. But all bets are off in terms of how long the benefits will last.”
That’s why ongoing research is essential, he said.
“I’ve had many patients who have reported a very helpful response. It has provided them with several months of healing and health,” Fehling said. “Ketamine is a helpful, valid and strong option for many people.”
But depression is a complex and confounding illness.
“We can’t predict with accuracy yet which patients will respond to which medication,” Fehling said.
Despite the complexities of treating people with depression and other behavioral health challenges, it’s clear that for some people, the FDA approval of esketamine was absolutely critical.
“It was game-changing to have this drug approved for depression,” Fehling said. “This is a totally new class of drugs.”