High levels of ketamine were found in Matthew Perry’s body at the time of his death. Those levels were not from a ketamine infusion he had one and half weeks prior to his death.  Most likely they were from ketamine pills as the amount of ketamine in his system was high and pills were found at the scene. Dr. Mark Siegel, clinical professor of medicine at NYU Langone medical Center, breaks it down for us, stating Matthew Perry’s death was an accidental overdose from ketamine; drowning was secondary.

Dr. Siegel believes the dose Mr. Perry took was similar to a dose for anesthesia, which then hyper stimulated his heart and slowed his breathing. All of that occurred before he drowned. Thus, given Mr. Perry’s underlying  heart disease and use of buprenorphine to get off of opioids, it appears he overdosed and then drowned in the water. Cause of death: Acute effects of ketamine.

Tragic. We know he was fighting substance use. So what can we learn from this?

Ketamine was first used in the 1960s  as a horse tranquilizer. It was then used in the 1970s as an analgesic for surgeries and ER emergencies. But it also  became abused on the streets as Special K, a recreational drug. In the 1990s, recreational ketamine was known as a club drug used to have a psychedelic experience. The drug causes you to dissociate, lose judgment and experience mind-body separation. It can be inhaled, taken as a pill, snorted, or given under doctor’s supervision as an infusion.

Ketamine prescriptions and non-sanctioned use have sky-rocketed (increase of 500% since 2017), particularly in the area of depression and pain. This is mainly driven by for-profit clinics and telehealth services. It’s a profitable drug. Physicians can buy ketamine for less than $100 a vial and charge $500 to $1500 per infusion. Ketamine has become the trendy psychedelic therapy. However there is limited research as to its effectiveness. And ketamine use carries significant safety issues and abuse risks.

Ketamine is only approved as a depression treatment for hard-to-treat depression known as treatment resistant depression, prescribed under the supervision of a physician with strict physician monitoring. It is not a first option for depression and is not approved for mild depression or anxiety.

Ketamine is a dissociative anesthetic drug that has similar properties to PCP (phencyclidine). Its effects are almost immediate and can last for several hours or for some people, several days.

In the brain, ketamine targets a chemical messenger called glutamate which we believe plays a role in depression and pain. However, there remain multiple concerns:

• Effects at low doses include disorientation, confusion, dizziness, nausea, vomiting.
• Changes in sensory perception include visual or auditory hallucinations.
• If someone has a diagnosis of schizophrenia, it can make psychosis worse.
• Those with a substance use history will experience the euphoria, trigger the opioid receptors and can can become addictive. This was potentially the case with Matthew Perry as he was taking a medication to help with opioid use disorder, buprenorphine.
• We don’t know what the effects of ketamine are on the teen brain, those breastfeeding or pregnant, or older people with dementia.
• At high doses, it can cause bladder damage.
• Less is known about the neurological effects but these may be concerning.
• It can elevate blood pressure and cause difficulty breathing.
• It can cause problems with judgment and coordination.
• Other side effects include seizures and amnesia.

It has become popular for people to micro dose with psychedelic drugs. However, the science does not support micro-dosing. Self-medication with these drugs is not recommended. And we don’t know the long term effects of using dissociative drugs. It is also possible to develop withdrawal symptoms of depression, sleepiness and cravings.

Bottom line, the science does not support the casual use we see nor prescribing for mild depression and anxiety.