An autopsy report released Friday by the Los Angeles County medical examiner said the death of “Friends” actor Matthew Perry, found face down and unconscious in a hot tub at his home on Oct. 28, resulted from “acute effects”. ketamine, an anesthetic with psychedelic properties.
Ketamine has become increasingly popular as a treatment for treatment-resistant depression and other mental health conditions. It is also used for recreational purposes.
Mr. Perry had publicly acknowledged his long struggle with alcohol and drug use, but the report said he had been sober for 19 months and little was known about his relationship with ketamine.
What is ketamine and is it legal?
Ketamine is a short-acting injectable dissociative anesthetic that can have hallucinogenic effects at certain doses. This distorts visual and audio perceptions and allows users to feel detached from pain and their surroundings.
Developed as a battlefield anesthetic in the 1960s, ketamine has been legal since 1970 for use in humans and animals. It is frequently used as an anesthetic in children, especially in developing countries.
But psychiatric use of ketamine is still not approved or regulated, although it is increasingly used off-label to treat depression, suicidal ideation and chronic pain.
In 2019, the Food and Drug Administration approved a nasal spray version of ketamine for the treatment of treatment-resistant depression, marketed as esketamine.
Ketamine has abuse potential, causing moderate or low physical dependence or high psychological dependence, but experts consider it a safe drug.
Those who use it recreationally often snort the medication in powder form or administer it intranasally through a spray.
“People should not be afraid to use ketamine if it is prescribed by their doctor and administered correctly in a health care setting,” said Dr. Gerard Sanacora, director of the Depression Research Program. from Yale and co-director of Yale New Haven Hospital. Interventional Psychiatry Department.
Can ketamine be fatal?
Ketamine is rarely fatal, but an overdose can cause loss of consciousness and dangerous slowing of breathing, according to the Drug Enforcement Administration. The amount of ketamine found in Mr. Perry’s body was extremely high, comparable to a dose of anesthetic, the medical examiner’s office wrote.
Side effects like increased blood pressure and paranoia are rare and usually occur very high doses. Frequent users of this medication may develop bladder problems.
In October, the FDA issued a warning about the dangers of using compounded versions of ketamine. Compounded medications are those that have been modified or adapted in the laboratory for the specific needs of an individual patient.
The agency, citing reports of adverse incidents, warned that unsupervised use of compounded ketamine increased the risk of dangerous psychiatric reactions and health problems like increased blood pressure, respiratory depression and problems with breathing. urinary tract which can lead to incontinence.
Dr. Steven Radowitz, chief medical officer of Nushama, a ketamine clinic in New York, said patients must undergo a complete medical and psychiatric examination “to ensure they are suitable for treatment.”
At Nushama and other clinics, doses are administered at “subanesthetic” levels so that patients remain conscious during their therapy sessions, Dr. Radowitz said.
What do we know about Mr. Perry’s ketamine use?
Mr. Perry was receiving medically supervised ketamine infusion therapy to treat depression and anxiety, and he had received an infusion a week and a half before his death, according to the autopsy report. The medical examiner’s office determined the treatment was unrelated to his death because the drug only stayed in the system for a few hours.
Although the report does not say so, it suggests that Mr. Perry was using ketamine at home at the time of his death.
Law enforcement found no ketamine in his home, the medical examiner said.
The report does not detail the exact sequence of events that led to Mr. Perry’s death, but it cites three contributing factors: drowning, coronary heart disease and buprenorphine, a prescription medication he took to treat his drug addiction. opioids.
“At the high levels of ketamine found in his postmortem blood samples, the primary lethal effects would come from both cardiovascular overstimulation and respiratory depression,” the report said.
In large doses, ketamine can cause dangerous changes in arterial pressure this can be particularly harmful to people with cardiovascular disease.
The sedative effects of ketamine could have been made worse by the buprenorphine Mr. Perry was taking.
Dr. Sanacora of Yale University said the plethora of risk factors made it difficult to identify the cause of Mr. Perry’s death.
“I’m not a coroner or medical examiner, but he had a lot of risk factors and a lot of potential things that could have happened,” he said. “The most important point to remember is that ketamine is not a drug to take at home.”