Matthew Perry's death means hard questions for the ketamine movement

• Matthew Perry died from the "acute effects" of ketamine, a dissociative anesthetic.
• The drug also has lifesaving potential as a treatment for depression.

When Charles Patti read that ketamine had been a major factor in the "Friends" star Matthew Perry's death, his heart sank.

"Oh, boy, this headline is not positive for the movement," he thought.

Patti is the chief brand officer at a Florida-based chain of ketamine clinics. Like many in the industry, he sees ketamine as a wonder drug with the potential to save the lives of patients with treatment-resistant depression.

Yet following Perry's death, rhetoric has focused, understandably, on ketamine's dangers. According to an autopsy report from the Los Angeles County medical examiner's office, 54-year-old Perry, who was found unresponsive in the "heated end of his pool" on October 28, died from the "acute effects" of ketamine, a dissociative anesthetic increasingly prescribed for depression and anxiety. Contributing factors to his death were listed as drowning, coronary artery disease, and a drug called buprenorphine, which is used to treat opioid addiction.

Multiple researchers told Business Insider that labeling ketamine as the sole cause of Perry's death is misleading. Still, news outlets and pundits leaped at the bait. "Matthew Perry's ketamine overdose should be a lesson in expanded use of the dangerous drug," declared The New York Post. "There is no evidence ketamine benefits mental health beyond placebo effects and the drug-induced high," Joanna Moncrieff, the controversial British psychiatrist and psychiatric-drug skeptic, posted to her 24,000 followers on X.

"We are about to see the most unhinged misinformation news cycle about ketamine and I am already so exhausted," posted Dr. Ryan Marino, who specializes in addiction treatment and often uses his X account to call out drug disinformation.

Celebrity deaths can have an outsize impact on policy. Marilyn Monroe's overdose death in 1962 drew attention to the dangers of barbiturates. David Herzberg, a drug historian at the University of Buffalo, said her death contributed to the first significant legal restraints on the sale of stimulants and sedatives a few years later. In 1986, the death of the college basketball star Len Bias due to a cocaine overdose pushed Congress to pass the draconian and racist Anti-Drug Abuse Act.

Black-and-white thinking has long informed the discourse on drugs in this country: from the War on Drugs, which disproportionately targeted people of color in its quest to demonize psychoactive drugs, to the opioid crisis, in which reckless pharmaceutical marketing spun an addictive substance as a harmless cure-all. This is why, when it comes to ketamine, it's important to keep nuance in conversation.

"These are truly amazing treatments, but they have real inherent risk," said Dr. Gerard Sanacora, a leading ketamine researcher and professor at Yale. Moments like this one force us to "take a big step back and talk about what we know and what we don't."

Ketamine has a long and winding history. In the 1960s, doctors began using it as an anesthetic and painkiller. In the 1980s and '90s, it became a popular street drug and a staple of rave culture. But in the past decade, it's taken on a new identity as a revolutionary mental-health treatment.

Starting in the early 2000s, multiple peer-reviewed studies found that ketamine is remarkably effective for patients with treatment-resistant depression. By 2010, doctors had begun prescribing the drug off-label in intravenous form, and in 2019, the FDA approved a ketamine nasal spray called Spravato.

Since then, the drug has fully entered the mainstream. Hundreds of ketamine-therapy centers have popped up all over the country, offering IV infusions for everything from eating disorders to addiction. Chic clinics strewn with crystals and bean-bag chairs are advertising ketamine as a wellness tonic as harmless as green juice. Meanwhile, telehealth clinics have begun sending ketamine lozenges in the mail. Celebrities from Chrissy Teigen to Elon Musk have spoken about their positive experiences with ketamine therapy, and Instagram and TikTok influencers gush about how it changed their lives.

Some scientists and journalists have worked to make people aware of ketamine's risks; in October, the FDA put out a warning about compounded ketamine, or the many prescribed forms of ketamine that aren't FDA approved. But the hype has generally drowned out these discussions. "We've decided that if a treatment is popular, that means that it is good," Herzberg said. "And we know that that's going to invite a lot of unethical marketing activity."

Perry, who struggled with opioid-use disorder for decades, wrote about trying ketamine at a Swiss rehab clinic in his 2022 memoir. He concluded that the drug, which felt like "being hit in the head with a giant happy shovel," wasn't for him. Still, his prescription ketamine use continued. According to the coroner's report, he received an IV ketamine infusion to treat depression and anxiety the week before his death.

At some point, Perry seems to have segued from prescription use to sourcing the drug on his own. The amount of ketamine in his bloodstream when he died was far higher than the clinical dose, similar to what surgical patients get for anesthesia.

There's no data on how many people go from receiving ketamine treatment in clinics to using it without a prescription. Last year, though, for an article about ketamine's addictive potential, I spoke to a number of people who were introduced to the drug by doctors but — for convenience, financial reasons, or because they were craving higher doses — eventually began purchasing it illegally.

Ketamine doesn't cause physical cravings like opioids, but it can be extremely psychologically addictive. People who use it heavily describe cognitive decline and memory loss, kidney and bladder issues, and trouble maintaining personal and professional relationships. "I feel constantly on the edge of a massive panic attack and have suicidal thoughts from the moment I wake up," one person wrote on the Ketamineaddiction subreddit last year. "I hope this hell of an addiction to nobody."

After Perry died, someone else wrote on the forum that they hoped his death would "put the spotlight on this drug" and inspire people to "stop acting like it's 'not really that dangerous.'"

The portrayal of ketamine as a miracle cure with minimal side effects has "misled a lot of people," Sanacora said. "I've had so many patients come to me and say, 'I don't want to take an antidepressant, those have side effects I hear are dangerous, but I want to try ketamine.'"

At the same time, experts fear that backlash against ketamine could scare away people who could benefit from it. "How we use ketamine in a clinic setting for depression is very, very different than what happened here," said Dr. Sandhya Prashad, the head of the nonprofit American Society of Ketamine Physicians, Psychotherapists, and Practitioners, who emphasized that ketamine is generally very safe when used under medical supervision. Unlike opioids, ketamine doesn't tend to affect respiration, and dying of an "overdose," as The New York Post headline referred to it, is uncommon.

BI spoke with four ketamine research experts, all of whom said it's probably more accurate to say the primary cause of Perry's death was drowning — though, of course, he wouldn't have drowned without a large dose of ketamine to knock him out.

"It was most likely a case where he ended up not recognizing that he was drowning and not being able to respond," said Keith Trujillo, a psychologist who has studied ketamine extensively. "I'm fairly confident that he would not have died had he been in his bed."

Trujillo noted that the other drugs in Perry's system, buprenorphine and lorazepam, which is used to treat anxiety, may have caused a negative interaction. People often focus on "the drug that catches their eye when they do their toxicology," he added, noting that the headlines would have been "very different" if Perry had drowned while drunk. While this may feel like semantics, it's important that people are informed about the specific risks of any drug — for example, how dangerous it is to take ketamine around water unsupervised.

Herzberg, the historian, said he's not particularly worried about Perry's death causing a moral panic. In the past, celebrity deaths have been co-opted by (often right-wing) interest groups to advance their existing agendas. But right now, there's fairly widespread bipartisan enthusiasm about drugs like psychedelics being used for mental-health treatment. If the politicians stay out of it, Herzberg said, this could be an opportunity for "rational caution" from public-health authorities.

Prashad, too, sees Perry's death as potentially forcing an educational moment. As her nonprofit said in a statement: "This is a wakeup call for ketamine practitioners and the wider medical community to put clear and unified guardrails in place" that will "protect the people who need this treatment most."