It was with great sadness that the world lost a point of light when Matthew Perry passed away in October of this year. As many of you know, the Medical Examiner’s report was released to the press recently.
Some of the headlines were misleading, therefore, I want to set the record straight in hopes of easing some fears that the reports have stoked.
According to the report, “Mr. Matthew Perry’s cause of death is determined to be from the acute effects of ketamine. Contributory factors in his death include drowning, coronary artery disease, and buprenorphine effects. The manner of death is accident (drug and drowning-related).”
To get clicks, some news outlets have been leading with headlines or first paragraphs talking about how Mr. Perry was receiving ketamine infusions for depression, suggesting a relation to his death.
However, Matthew Perry’s last ketamine infusion was a week and a half before his demise. Since the half-life of ketamine is 3 hours, it was 99.5% out of his system the next day. The medical examiner concludes that “the ketamine in his system at death could not be from that infusion therapy”.
The fact that news outlets are suggesting otherwise for clickbait is irresponsible journalism.
Another Source of Ketamine
Perry did have high levels of ketamine in his bloodstream at the time of death, and traces of ketamine were in his stomach upon autopsy.
This means that there was another source of ketamine, outside of his medical infusion ten days prior. Whether it was from misuse of a prescription from his provider, a mail-order ketamine provider or a street dealer is unknown.
The medical examiner’s report states that the blood level of ketamine found in Matthew Perry at the time of death was 3,540 ng/ml, well into the general anesthesia range. At that level, ketamine would be expected to cause loss of consciousness and depressed breathing.
Still, he may have survived if not for additional factors cited in the report.
Matthew Perry was also found with sedatives in his system (lorazepam and buprenorphine) which would have worsened the respiratory depression.
And most notably, he was alone in his swimming pool.
Dr. Andrew Stolbach, medical toxicologist with Johns Hopkins Medicine, told the Associated Press that the level of ketamine found in Perry’s blood, “would be enough to make him lose consciousness and lose his posture and his ability to keep himself above the water.” Further, he said, “Using sedative drugs in a pool or hot tub, especially when you’re alone, is extremely risky and, sadly here it’s fatal.”
Comparative Drug Levels.
Below is a table adapted from Pharmacol Rev 70:621–660, July 2018
|Oral – ?
|IV 1-2 mg/kg bolus
|Sussman (1974), Idvall et al. (1979) Clements et al. (1982), Gao et al. (2016)
|Awakening from General Anesthesia
|Idvall et al. (1979)
|IV – 0.15 mg/kg bolus
Oral – 0.5 mg/kg
|Grant et al. (1981), Clements et al. (1982), Marchetti et al. (2015)
|IV – 0.5 mg/kg over 40 minutes
|Zarate et al. (2006)
As you can see, Matthew Perry’s plasma level was 19 times the level seen during a ketamine treatment for depression. (And was complicated by additional sedatives and being unattended in the pool.)
Assuming that he took ketamine by mouth where it is less than 20% absorbed and that he weighs close to 100 kg (216 pounds per autopsy report), the amount of ketamine needed to get to that blood level is close to 4,000 mg (39.3 mg/kg).
Matthew Perry’s death was tragic, and he will be missed by many. Ketamine is implicated in his death, however, the high level in his system was not from his IV ketamine sessions. It resulted from him obtaining ketamine from another source and taking extremely large doses in an unsupervised manner.
All of this is to say that ketamine is a safe medication when used appropriately, in a medical setting. But like any other drug, ketamine must be used responsibly.
There is no doubt that ketamine improves and even saves lives. We hear this from our patients nearly every day. At Edelica, we will continue to advocate for the safe, appropriate, and responsible use of ketamine for the benefit of people with treatment-resistant depression and chronic pain.
-Kevin J. Kane, MD
Medical Director, Edelica Health
Dr. Kane is a board-certified anesthesiologist, and member of the American Society of Ketamine Physicians, Psychotherapists and Practitioners (ASKP3). He is founder and medical director at Edelica Health in Milwaukee.
Edelica Health (formerly Ketamine Milwaukee) is the first clinic in Wisconsin dedicated to IV ketamine for treatment-resistant depression and chronic pain. Edelica Health has provided over 8,000 safe ketamine treatments since opening in 2017.