After Matthew Perry’s cause of death was listed as “acute effects of ketamine” on Friday, experts are speaking out about misconceptions surrounding the drug.
(Other conditions that contributed to Perry’s death, according to the autopsy report, included “coronary artery disease [and] buprenorphrine effects.” Also, “prescription medications and loose pills” were found at the residence, the report said.)
Ketamine is primarily used as an anesthetic during surgical procedures — but in recent years it’s been used as a remedy for treatment-resistant depression.
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The Alcohol and Drug Foundation (ADF) describes ketamine as a “dissociative drug,” which means it causes people to feel “separated or detached” from their bodies or physical surroundings.
While it is also used illegally as a recreational drug, experts say ketamine is generally not dangerous when used as prescribed.
“The concentration of ketamine found in Matthew Perry’s blood was sufficient to cause loss of consciousness and lack of responsiveness to external stimulation,” Lewis Nelson, chair of the Department of Emergency Medicine and chief of medical toxicology at Rutgers New Jersey Medical School, said in a statement provided to Fox News Digital.
“This explains why he slipped under the water and did not awaken. Ketamine does not generally cause death from cardiac or respiratory effects, but rather from associated injury.”
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Dr. Bankole Johnson, CEO and founder of Casa Privée in Miami, a concierge medical facility, offers ketamine infusion therapy to help patients manage various conditions.
He told Fox News Digital that in his opinion, Perry’s death likely was linked to recreational ketamine use, although he did not treat or examine the actor.
Experts shared with Fox News Digital the following common myths and misconceptions about the drug.
In reality, the drug has been used for depression, post-traumatic stress disorder and pain for more than 10 years, according to Dr. Patrick Sullivan, medical director of Initia Nova Medical Solutions in New Jersey.
The FDA approved ketamine for anesthesia in both humans and animals since 1970, the doctor noted.
After successful clinical trials, the FDA approved the drug in 2019 as a medication for treatment-resistant depression.
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“There are hundreds of studies showing it to be safe and effective in the outpatient setting,” Sullivan told Fox News Digital.
Ketamine is “legally recognized as having the potential for abuse and for both psychological and physical dependence,” according to the American Addiction Centers website.
Johnson, however, noted that ketamine is a “moderately addictive substance.”
He told Fox News Digital, “Even long-term users typically only develop a behavioral or psychological dependence. Physical dependence can occur, but usually the withdrawal signs are mild to moderate.”
Dr. Sandhya Prashad, president of the American Society Of Ketamine Physicians, Psychotherapists and Practitioners (ASKP3) in Florida, said there is “an extremely low risk of addiction, craving or withdrawal” when ketamine is used in low doses in a monitored clinical setting.
“Abuse of ketamine occurs when it is self-administered in high or frequent doses without supervision or monitoring, which leads to addiction,” she told Fox News Digital.
Ketamine should only be obtained and administered by a licensed and experienced medical doctor, Johnson said.
“To use ketamine, it is important to establish a clear diagnosis of severe depression or anxiety and/or post-traumatic stress disorder,” he told Fox News Digital. “This requires an expert and cannot be self-diagnosed properly.”
Those who think they may benefit from ketamine treatment should consult a doctor, Johnson advised.
“Ketamine is generally safe when administered by trained health professionals in a medical setting,” Johnson said.
“In those settings, it is best delivered by the IV route, where the dose can be calculated accurately.”
When purchasing ketamine outside a doctor’s prescription, there is also the risk of receiving a tainted product, experts warned. While people might assume they’re purchasing straight ketamine, the drug is often mixed with stimulants like cocaine or phencyclidine (PCP), Johnson noted.
“These can produce strong cardiac effects of a very high blood pressure and pulse, and can lead to serious medical complications,” he said.
While using small doses of ketamine may seem safer than the larger doses given via IV, Johnson warned that when this drug is self-administered, there is a danger of exceeding safe limits.
“The total cumulative dose could end up being higher than a standard dose of a medically administered intravenous dose,” he told Fox News Digital.
Intranasal use can also lead to “more aggressive drug-seeking” behaviors, Johnson warned, as the “high” of taking the ketamine is paired with cues in the user’s environment — which are not present in a medical office.
Like other medications, such as opiates or benzodiazepines, ketamine has the potential to be abused, Sullivan agreed.
“Ketamine should only be used within the confines of a close relationship between a patient and an experienced prescriber,” he said, citing the position reaffirmed by ASKP3.
“Weaning off ketamine is typically not too difficult, as the medicine has a half-life of three to four hours, and most is eliminated by the body in a single day,” said Johnson.
Gradual dose titrations of ketamine — in which the amounts are slowly increased or decreased — are recommended for starting and stopping the medication, the expert noted.
Ketamine can become dangerous in a few ways, according to experts.
“First, if a patient has access to use it at home for pain or mood, this can increase the likelihood of developing a physical or psychological dependence,” Sullivan told Fox News Digital.
Experts recommend that home use of ketamine is only prescribed for select patients — who should be closely monitored with regular face-to-face office visits.
“Another way it can become dangerous is if a patient uses too large of a dose in an unsupervised setting, where they may put themselves at risk for accidents, such as falls or drownings,” said Sullivan.
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Mixing ketamine with other medicines can also be dangerous, Johnson warned.
For example, when mixed with opiates, it can have a stronger sedative effect, and combining ketamine with stimulants can worsen cardiovascular effects, he said.
In particular, ketamine mixed with buprenorphine can enhance sedation and lead to unresponsiveness, said Johnson.
Buprenorphine, a drug that is prescribed to treat opioid use disorder, was in Perry’s system at the time of his death.
ASKP3 announced that it will soon publish guidelines for safe use of the drug.
“In the wake of Matthew Perry’s autopsy report, we are committed to creating and publishing guidelines for at-home ketamine use, which should only be practiced with a very specific patient profile and only in the context of a close relationship with a physician and in-office follow-up,” the organization said in a released statement.
It is important for people to recognize the distinction between different uses of the drug, according to Prashad.
“In reality, the ways in which ketamine is used for anesthesia versus depression versus abuse are all very different in terms of dosage and frequency.”
