Matthew Perry is the latest in a line of deceased celebrities, including Elvis Presley and Michael Jackson, whose physical decline and tragic death were enabled by unscrupulous doctors. But in Perry’s case, the media have gone beyond that story to indict the drug itself.
My concern is that the unusual circumstances and heavy publicity surrounding Perry’s death might discourage needed research on ketamine’s anti-depressant properties. Even worse, it could complicate efforts to convince regulators to approve ketamine’s use, at low doses, to treat severe pain on the battlefield and civilian emergency care.
Perry’s Tragic Descent
Perry wrote about his struggles with addiction in a memoir published in 2022. A few years ago, while in drug rehab in Switzerland, he received medically supervised infusions of ketamine “to ease pain and help with depression.” Upon returning to the U.S., he initially sought the drug from doctors in clinics but turned to illicit sources to secure larger and more frequent doses. Soon, he was receiving daily injections in his home. Then, on October 22, 2023, he was found floating face-down in a hot tub in his Los Angeles home.
Two months later, the L.A. County coroner ruled that Perry’s death was caused by “acute effects of ketamine.” Drowning, coronary artery disease, and concurrent use of an opiate, buprenorphine, were listed as “contributing factors.” Earlier this month, two of Perry’s doctors, his personal assistant and two additional people were charged with supplying him with the drug.
In light of ketamine’s favorable safety profile, I was surprised by the coroner’s ruling. So were other doctors. In on-air remarks, CNN’s Dr. Sanjay Gupta observed that the level of ketamine in Perry’s system was high, but “In and of itself, it’s not likely to lead someone to die … except he was also in a swimming pool.” Gupta added that one of the toxicologists he spoke to said that “Ketamine isn’t likely what killed him, but it made it rather possible for him to drown.”
Legitimate Uses Of Ketamine
Ketamine has been safely used as an anesthetic for more than five decades. At high doses, it provides sedation, pain relief and amnesia without depressing breathing, airway reflexes, or blood pressure. These properties make it a mainstay for anesthesia worldwide. The World Health Organization classifies ketamine as an “essential medicine.”
In the aftermath of Perry’s death, many press reports focused on ketamine’s growing use for treatment-resistant depression. When it is administered under medical supervision, it is generally safe—and for some patients who haven’t responded to conventional anti-depressant treatments—highly effective. However, ketamine should never be used for self-treatment. Perry readily evaded this caveat by turning to sources willing to supply him with ever-increasing doses. For this reason, I worry that the rapid proliferation of “ketamine clinics” and telehealth prescribing may prompt regulators to sharply restrict access to this helpful drug.
At low doses—well below those used for anesthesia—ketamine retains its potent pain-relieving effects. This makes it a useful alternative to morphine, fentanyl and other opioids for treating severe pain in emergency situations. First used for this purpose in Afghanistan and Iraq to treat combat casualties, ketamine worked so well that it’s been adopted by many civilian EMS agencies. If the FDA authorized its use to treat pain in emergency care settings, manufacturers could pre-package the drug in low dose vials as they do with other emergency medications. This would make it easier and safer to administer in emergencies, and harder to divert than large multi-dose vials.
Context Matters
No medication is completely safe, but ketamine is safer than most. About 107,000 overdose deaths occurred in the U.S. in 2023, according to CDC’s National Center for Health Statistics. Deaths from opioids decreased from 84,000 in 2022 to 81,000 in 2023, while deaths from stimulants such as cocaine and methamphetamine increased. In contrast to these vast numbers, deaths from ketamine overdose are rare. Those that occur often involve concurrent abuse of several different drugs.
Had Matthew Perry taken a nap on his couch instead of climbing into his hot tub, he’d probably be alive today. Long used as a safe and effective anesthetic, ketamine appears to have potent pain-relieving and antidepressant properties. Although safer than most drugs with these properties, it can be abused. Therefore, it should only be administered under the watchful eyes of well-trained and ethical healthcare professionals. These are the lessons we should draw from Matthew Perry’s death.
