Let’s learn the right lessons from Matthew Perry’s death

Matthew Perry is the latest in a line of deceased celebrities, including Elvis Presley and Michael Jackson, whose physical decline and tragic deaths were made possible by unscrupulous doctors. But in Perry’s case, the media has gone beyond that story and denounced the drug itself.

My concern is that the unusual circumstances and heavy publicity surrounding Perry’s death could discourage necessary research into the antidepressant properties of ketamine. Worse, it could complicate efforts to convince regulators to approve the use of ketamine, in low doses treat severe pain on the battlefield and civilian emergency response.

Perry’s Tragic Origin

Perry wrote about his struggle with addiction in a memoirs published in 2022. A few years ago, when I was in rehab in Switzerland, he received medically supervised infusions of ketamine “to relieve pain and help with depression.” Upon his return to the US, he initially sought out the drug from doctors in clinics, but turned to illegal sources to obtain larger and more frequent doses. Soon he received daily injections in his house. He was then found face down in a hot tub at his Los Angeles home on October 22, 2023.

Two months later, the LA County coroner ruled that Perry’s death was caused by “acute effects of ketamine.” Drowning, coronary artery disease and concurrent use of an opiate, buprenorphine, were listed as ‘contributing factors’. € Earlier this month, two of Perry’s doctors, his personal assistant and two other people were accused of supplying him with the drug.

In light of ketamine’s favorable safety profile, I was surprised by the coroner’s ruling. This also applied to other doctors. In broadcasts, Dr. CNN’s Sanjay Gupta noted that the level of ketamine in Perry’s system was high, but “on its own it is not likely to cause anyone to die.” ¦ except he was also in a swimming pool.†Gupta added that one of the toxicologists he spoke to said: “Ketamine is not likely to have caused his death, but it did allow him to drown.†€

Legitimate use of ketamine

Ketamine has been used safely as an anesthetic for more than fifty years. At high doses, it provides sedation, pain relief, and memory loss without depressing breathing, airway reflexes, or blood pressure. These properties make it a mainstay for anesthesia worldwide. The World Health Organization classifies ketamine as an “essential medicine.”

In the wake of Perry’s death, many press reports focused on the increasing use of ketamine for treatment-resistant depression. When given under medical supervision, it is generally safe – and for some patients who have not responded to conventional antidepressants – very effective. However, ketamine should never are used for self-treatment. Perry easily sidestepped this caveat by turning to sources willing to provide him with increasingly larger doses. For this reason, I fear that the rapid increase in the number of “ketamine clinics” and telehealth prescribing may prompt regulators to sharply restrict access to this useful drug.

At low doses – well lower than those used for anesthesia – ketamine retains its powerful analgesic effect. This makes it a useful alternative to morphine, fentanyl and other opioids for treating severe pain in emergency situations. Ketamine was first used for this purpose in Afghanistan and Iraq to treat combat casualties and worked so well that it has been adopted by many civilian ambulance services. If the FDA were to approve its use for treating pain in emergency rooms, manufacturers could prepackage the drug in low-dose vials, as they do with other emergency medications. This would make it easier and safer to administer in an emergency, and more difficult to divert than large multi-dose vials.

Context is important

No drug is completely safe, but ketamine is safer than most. According to the CDC, approximately 107,000 overdose deaths occurred in the U.S. in 2023. National Center for Health Statistics. Deaths from opioids fell from 84,000 in 2022 to 81,000 in 2023, while deaths from stimulants such as cocaine and methamphetamine increased. In contrast to these enormous numbers, there are deaths from ketamine overdose rare. In the cases that do occur, it is often accompanied by simultaneous abuse of several medications.

If Matthew Perry had taken a nap on his couch instead of climbing into his hot tub, he would probably still be alive. Ketamine has long been used as a safe and effective anesthetic and appears to have powerful analgesic and antidepressant properties. Although it is safer than most medications with these properties, it can also be abused. Therefore, it should only be administered under the watchful eye of properly trained and ethical healthcare professionals. These are the lessons we should learn from Matthew Perry’s death.