Why Did We Lose Matthew Perry of “Friends” Fame? 

 

The world was shocked in October of 2023 to learn that popular actor Matthew Perry had died. Perry had struggled with addiction to alcohol and opioid painkillers for decades. He went from one drug rehab to another, visiting 15 different rehabs and spending as much as $9 million on his recovery attempts.

Finally, he was reportedly sober at the time of the publication of his 2022 memoir, Friends, Lovers, and the Big Terrible Thing. Then, in October of the following year, he was found dead in a hot tub at his Pacific Palisades home.

After more than a month of waiting, the cause of Perry’s death has finally been determined. It resulted primarily from the effects of ketamine, a dissociative, anesthetic drug. Heart disease, buprenorphine (a prescription opioid drug), and drowning were other contributing factors. Perry was also under the influence of two different benzodiazepine drugs used to treat anxiety.

But it was not simply a drug overdose that killed Perry. Nor was it what is usually called “mixed drug toxicity,” meaning that it was the combined effects of all the drugs he had taken that stopped his heart or breathing. It was primarily the effects of a drug used for medical and veterinary anesthesia that caused him to lose consciousness and drown in his backyard hot tub.

What Is Ketamine?

 

Ketamine is both a prescription drug and a drug of abuse. For years, it was used as an anesthetic on the battlefield in Vietnam or in hospitals. People coming out of the drug suffered severe disorientation and psychotic episodes, so its use in humans was drastically limited. It continued to be used as a sedative and anesthetic for animals.

In the 1990s, the use of ketamine increased dramatically as researchers tried out new applications for the drug with limited success. It began once again to be used by itself or with other drugs as a general anesthetic. Increasingly, however, ketamine is being used off-label for depression. Its use as a psychiatric drug is fairly new, but over the past decade, retail stores, clinics, and mail-order services have been quick to jump on the bandwagon and are furiously looking for new clientele. The result is a hodge-podge of local regulations, prompting the FDA to issue a warning in October. Further warnings from Yale Medical School illustrate just how bad the situation has become. Based on little research, a cottage industry has popped up prescribing ketamine for at-home use and mail-order delivery. And while the promise of the drug was that it would treat depression, addiction is a contraindication, and ketamine therapy should never be used in combination with treatment for addiction. The undeniable fact is that ketamine is very addictive, and its abuse is growing.

Soon after the drug started being used by doctors, it also became a popular drug of abuse, especially in Asia. In the U.S., supplies of ketamine were originally stolen from veterinary practices and sold on the illicit market. When illicit drugs became available on the internet, ketamine became easier to obtain. Now, it can be shipped directly from overseas manufacturers. Drug traffickers also obtain the drug in other countries and traffic it into the U.S.

Pharmaceutically, ketamine is known by its brand names Ketaset and Ketalar. On the street, it may be called Cat Tranquilizer, Cat Valium, Special K, or Vitamin K.

Understanding Ketamine and Its Effects

In addition to being used for physical ailments, infusions of ketamine are now being prescribed for intractable depression or depression that would not respond to other treatments. Multiple infusions are administered for this purpose. Perry had been receiving this treatment. He had not received an infusion for the prior one-and-a-half weeks, so that was not the reason he had ketamine in his body at the time of his death. The drug lasts only hours once it is administered.

No reports from police note any prescriptions of ketamine lying around his home, although he did have other prescription medications. It is possible, then, that he had obtained ketamine from an illicit source and consumed it on his own volition.

Ketamine’s effects:

• Hallucinations
• Distortions of sight and sound
• Feeling of being disconnected
• Loss of control
• Immobility
• Relief from pain
• Sedation
• Unconsciousness
• Amnesia

It also causes the following undesirable side effects:

• Dizziness
• Nausea
• Vomiting
• Elevated heart rate
• Elevated blood pressure
• Bladder damage

Ketamine for General Anesthesia

While the use of ketamine as a general anesthetic declined in the 1970s, its popularity increased again in the 1990s. When used for human anesthesia, dosages are used to bring blood levels to between 1,000 and 6,000 nanograms per milliliter of blood. (A nanogram is one-billionth of a gram. A milliliter is one-thousandth of a liter.)

A person using ketamine recreationally will generally use a lower dose than what is used for general anesthesia. Perry’s blood levels of ketamine were 3,540 ng/ml or 3,271 ng/ml, depending on where on his body the sample was taken. This means that Perry’s consumption of ketamine far exceeded a recreational dose and instead was in the middle of a medical anesthesia range.

What Is Buprenorphine? 

 

Buprenorphine is another drug that was found in his body. It is an opioid drug used both as a pain reliever and as a drug for the treatment of addiction to other opioids. A person who was abusing OxyContin or who had been addicted to heroin might be prescribed buprenorphine after they enter treatment. This drug helps the person quell their cravings for other opioids. Unfortunately, it also keeps a person dependent on an opioid medication. Some medical experts suggest that buprenorphine is best used temporarily as a transition from addicted to fully sober, a transition that might last just a few weeks.

As Perry had spent many years struggling with opioid addiction, he could have been prescribed this drug as part of a treatment program.

How Could Ketamine Have Contributed to His Death?

The sedating and dissociating effects of this drug, along with its ability to make people lose control and consciousness, apparently caused Perry to slip into the heated water, resulting in his drowning.

In his 2022 memoir, Perry commented on the effects of his ketamine infusions:

As I lay there in the pitch dark, listening to Bon Iver, I would disassociate, see things—I’d been in therapy for so long that I wasn’t even freaked out by this. Oh, there’s a horse over there? Fine—might as well be... As the music played and K ran through me, it all became about ego, and the death of ego… And I often thought that I was dying during that hour…‘Oh,’ I thought, ‘this is what happens when you die.’

His autopsy report noted:

The County of Los Angeles Department of Medical Examiner (DME) determined the cause of death for 54-year-old actor Matthew Langford Perry as the acute effects of ketamine. Contributing factors in Mr. Perry’s death include drowning, coronary artery disease and the effects of buprenorphine (used to treat opioid use disorder). The manner of death is accident.

A medical toxicologist who reviewed the autopsy report stated that the quantity of ketamine in Perry’s blood “would be enough to make him lose consciousness and lose his posture and his ability to keep himself above the water.”

The combination of ketamine, buprenorphine and being all alone in a hot tub combined to cause the death of this beloved actor. It was another accidental death, added to the hundred thousand others we lose every year to overdoses.

Were These Multiple Prescriptions a Good Idea for a Person in Recovery?

Dr. Drew Pinsky, an addiction specialist and host of television’s “Ask Dr. Drew” show, weighed in on the dangers of Perry having been prescribed the medications found in his body. He said:

It wasn’t just the ketamine. It’s very important to understand here that he was on buprenorphine, he was on two different benzodiazepines, which for a recovering addict is…wild, it’s dangerous, and for somebody with addiction, you see where it goes. It’s a terrible tragedy.

A Final Word

In his many years in recovery, Perry reached out to many other people who were trying to find sobriety. He knew he was not alone in his struggle and wanted to help others escape that daily battle. He advocated for drug courts to enable some people to avoid incarceration for drug offenses. He opened a sober living home. He testified before Congress. He was setting up a charitable foundation at the time of his death.

“I’ve helped 100,000 people in a weekend, but I’ve also helped one guy. And it’s the same amount of juice that I get from it. It doesn’t matter when you see the lights go on in somebody’s eyes who’s been hammered or on drugs for 10 years. That’s what makes your heart grow...”

In a November 2022 interview, he said:

I’ve helped 100,000 people in a weekend, but I’ve also helped one guy. And it’s the same amount of juice that I get from it. It doesn’t matter when you see the lights go on in somebody’s eyes who’s been hammered or on drugs for 10 years. That’s what makes your heart grow. And that’s a wonderful thing… When I die, I don’t want Friends to be the first thing that’s mentioned. I want [helping others] to be the first. And I’m gonna live the rest of my life proving that.

Sources:

• “Matthew Perry’s Radical Honesty About His Addiction Battle Helped Us All.” Rolling Stone, 2023. Rolling Stone

• “Ketamine and Its Emergence in the Field of Neurology.” National Library of Medicine, 2022. NLM

• “Dr. Drew: Matthew Perry autopsy shows ‘bizarre’ drug combinations.” NewsNation, 2023. NewsNation

• “Matthew Perry spoke openly about ketamine therapy in his 2022 memoir. Here's what he said.” Today.com, 2023. https://www.today.com/health/news/matthew-perry-ketamine-therapy-rcna130105

• “Cause and Manner of Death Determined for Matthew Langford Perry.” Medical Examiner of LA County, 2023. ME.LACOUNTY.GOV

• “If Ketamine Is So Safe, What Happened to Matthew Perry?” MedPage Today, 2023. MedPage Today

• “Matthew Perry’s Lasting Legacy: How He Won Our Hearts and Found a Mission Helping Others with Addiction.” People Magazine, 2023. People Magazine