Matthew Perry's death sparks debate on ketamine: Balancing medical benefits and recreational risks

Matthew Perry died from acute effects of ketamine, according to a newly released autopsy report that found high levels of ketamine in the body. Coronary artery disease and buprenorphine also contributed to the death, with drowning as a secondary factory, according to the Associated Press.^[]

The “Friends” star, whom castmates remember as open-hearted, was found dead in his hot tub this October.^[] 

Ketamine: medicinal benefits and recreational risks

Ketamine can be used safely in some anesthesia and mental health treatments, but uncontrolled use or overuse can be dangerous. For medical anesthesia or mental health purposes, ketamine tends to be given as an infusion. Perry received a monitored ketamine infusion about a week before his death. Given the time between the treatment and the incident, however, doctors say that the infusion does not explain the ketamine levels revealed by the autopsy. 

Walavan Sivakumar, MD, a board-certified neurosurgeon and Director of Neurovascular Surgery at Pacific Neuroscience Institute-South Bay in Torrance, CA, explains that ketamine has a half-life of approximately 4 hours. With this in mind, “Matthew Perry's death is unlikely to be related to his monitored ketamine infusion approximately one week prior,” Dr. Sivakumar says. 

He adds that “overdoses and ketamine-related deaths are typically seen in the recreation[al] setting.” In recreational settings, ketamine can be taken in powder or liquid form and can be mixed with other drugs that may also increase its risk profile, Dr. Sivakumar says.

How can ketamine use lead to death?

Ketamine-related fatalities are rare but more common in recreational versus medical settings, Dr. Sivakumar says.

When deaths occur, “high doses of ketamine can result in neurologic, gastrointestinal and potentially cardiovascular or respiratory toxicity,” he adds.

Ketamine can also decrease respiratory rates, especially when mixed with other sedative agents, says Ashvin Sood, MD, an adult, child, and adolescent psychiatrist at Washington Interventional Psychiatry. This can reduce a person’s breathing rate and decrease the levels of oxygen getting to their vital organs, he says.

Uncontrolled doses of ketamine can also cause “transient increases” in blood pressure and heart rate, increasing risks for cardiovascular events like heart attacks, he adds.

“Additionally, high doses of ketamine can cause the brain to go into a dissociative state, preventing a person from responding to dangerous situations, such as drowning, which is what is believed to [have] happen[ed] to Matthew Perry, per the autopsy note,” Dr. Sood says.

Along with the dangers of using ketamine recreationally are the dangers of supporting its illicit market, Dr. Sood says. He encourages doctors and patients to avoid illegal sellers, including those online.

Guiding medical ketamine use

Perry’s autopsy sheds light on the importance of monitoring all drugs and therapies, even those that have positive medical uses.

“While ketamine has therapeutic potential, like any powerful medication, it must be administered with professional guidance [and] proper peer support to ensure safety,” says Sam Zand, psychiatrist, Founder of The Anywhere Clinic, and Chief Medical Officer of Better U. “We must learn from tragedies like this and maintain reverence for the medicine to use it with proper therapeutic intention.”

Zand adds that it is important for doctors to monitor patients to whom they are administering monitored ketamine therapy and provide comprehensive education on risks and benefits to discourage improper use.