Matthew Perry Likely Died From Taking Ketamine on His Own, Not From Supervised Infusion Therapy, Experts Say

Following the revelation that Friends star Matthew Perry died from “acute effects of ketamine,” all eyes are on the ketamine infusion therapy that the star had tried over a week prior.

Perry, who died in October at age 54, had done ketamine infusion therapy for depression and anxiety a week and a half prior to his death, according to the toxicology report from the Los Angeles County Medical Examiner’s Office obtained by The Messenger. 

The toxicology report noted that the ketamine in Perry’s system "could not be from that infusion therapy, since ketamine's half-life is 3 to 4 hours, or less.” 

Since his therapy session had taken place many days before, it’s probable he took ketamine on his own the day he died, likely without medical supervision, several experts, who did not treat Perry, tell The Messenger.

“Had Matthew Perry not been alone, he would not have died,” ketamine-assisted psychotherapist Kathryn Rheem, Ed.D., LMFT, says. 

The drug is “remarkably safe,” as long as it’s administered with a medical professional, Rheem says. 

“It is exceedingly rare to have someone die from ketamine therapy,” Lucas Trautman, M.D., medical director of the Mississippi-based addiction rehab Oxford Treatment Center, tells The Messenger. 

“This is a very safe medication when prescribed by a medical professional for the treatment of depression,” Dr. Trautman says.

If Ketamine infusion therapy is safe, why did Matthew Perry die?

Ketamine caused Perry both cardiovascular overstimulation and respiratory depression, the toxicology report said.

“[Ketamine] can increase heart rate, blood pressure and cardiac output — meaning the heart works harder and pumps out more blood per minute,” Sanford Medical Center cardiologist Siyab Panhwar, M.D., tells The Messenger. 

“For people who already have underlying heart disease and related conditions, a high dose of ketamine, especially unsupervised, could potentially cause acute heart problems by exacerbating their underlying heart condition. This is one of the many reasons people need to be monitored closely so we can monitor their cardiac function and vital signs and take corrective action if needed,” Dr. Panhwar says. 

Dr. Trautman adds that ketamine is “very unlikely” to cause respiratory depression “unless the drug is given at an extremely high dose, which would be outside the norm for the treatment of depression.” 

Perry’s other causes of death were drowning, coronary artery disease and the effects of buprenorphine, which is approved by the Food and Drug Administration to treat Opioid Use Disorder (OUD). 

Perry’s toxicology report called it “an opioid-like drug used in the treatment of opioid addiction as well as acute and chronic pain. The levels [in Perry’s system] were therapeutic for the drug,” meaning he took a dose that was within the recommended limits.

"There was no evidence of alcohol, methamphetamine, cocaine, heroin, PCP or fentanyl in his system,” the report said. 

Perry had been open about struggles with substance use disorder in the past, which would have put him under the category of people who should take extreme caution or avoid ketamine altogether, per Harvard Health. He also had emphysema and diabetes, according to the coroner’s report.

People with a history of psychosis or schizophrenia, teenagers, people who are pregnant or breastfeeding and older adults with dementia symptoms should avoid ketamine. 

Experts worry Perry’s death will trigger stigma about the drug

Many in the medical and mental health communities are concerned that Perry’s death will renew the stigma against ketamine and may deter some people who could benefit from the treatment. 

“This event could renew the stigma [established during] the war on drugs, but it shouldn’t,” Rheem says. “My phone’s been ringing off the hook over the weekend, text messages. I’ve had to reassure lots of people that ketamine-assisted psychotherapy is safe.” 

Medical experts say they’re encouraged by short-term studies, such as one from last year that showed significant decreases in suicidal ideation for those who received ketamine treatment rather than a placebo. 

“People should not be afraid of ketamine when used correctly,” Dr. Panhwar concurs. “But it needs to be used under medical supervision.”

If you or someone you know is struggling with addiction, help is available 24 hours a day through the Substance Abuse and Mental Health Hotline at 1-800-662-4357.

If you or someone you know is contemplating suicide or struggling with suicidal thoughts, help is available 24 hours a day through the Suicide and Crisis Lifeline at 988. You are not alone.