NBC News
In the weeks before his death, actor Matthew Perry, famous for his work on the television series Friendsconsumed large quantities of ketamine, the drug that caused his death, which was supplied by a network of doctors, his personal assistant, an acquaintance and a drug dealer, federal prosecutors reported Thursday in Los Angeles (California).
The 54-year-old actor was addicted to the drug, taking shots six to eight times a day before his accidental overdose death. Five people have been charged in connection with his death in October 2023, when he was found unconscious in the pool of his home in the Pacific Palisades area of Los Angeles.
Here’s what you need to know about ketamine.
What is ketamine?
It is a hallucinogenic substance that was approved decades ago by the Food and Drug Administration (FDA) as an anesthetic in surgery, but it is also used illegally as a recreational drug.
In recent years, a growing body of research suggests it can also treat depression in people who have tried other treatments without success. That has led to a rise in what’s known as “off-label use,” the legal practice of doctors prescribing an approved drug for a condition other than the one listed by health authorities.
How is ketamine used for depression?
Brandon Hamm, a psychiatrist who runs the ketamine infusion clinic at Northwestern Medicine in Chicago, explains that the drug’s value lies, in part, in how quickly it works.
“It is an important drug because it offers a rapid and effective response to a major cause of disability in some people,” Hamm said. “Treatment-resistant depression causes great suffering.”
In 2019, the FDA approved a slightly different version of ketamine, called esketamine or Spravato, for treatment-resistant depression. Esketamine is administered as a nasal spray in a doctor’s office. It is approved only for people for whom other depression treatments have failed.
Are ketamine clinics safe?
Those who have battled severe depression and found success with ketamine say it can save their lives. But there is growing concern among some doctors as hundreds of clinics have opened across the country. Some charge hundreds of dollars for infusions, injections and oral forms of the drug.
Clinics promote the drug as a treatment for everything from depression to obsessive-compulsive disorder to even addiction, but only a few smaller studies have looked at its benefits for mental health conditions beyond treatment-resistant depression.
What are the risks of ketamine?
“Ketamine is not without its risks,” Hamm points out. “It is very potent, so it also has its dangers, and it is important to prescribe it with caution.”
Risks include increased blood pressure, slow breathing, bladder problems, and substance abuse. It can also stop a person’s breathing if taken in excess or in combination with other medications or alcohol.
“If you give it intravenously, you can reach alarming, almost anesthetic dose ranges very quickly,” said Dr. Padma Gulur, a professor of anesthesiology at Duke Health in North Carolina. “We must not forget that this is something that needs to be done in a very controlled environment. Someone needs to be there to assist breathing, monitor vital signs, etc.”
Last fall, the FDA issued a warning about some types of ketamine, saying it is not approved for any psychiatric disorder, and cautioned against taking it at home, which can be even more dangerous without a doctor on-site to monitor for serious side effects of sedation and dissociation.
“It is not a drug that we know enough about in terms of safety and efficacy for long-term outpatient use, and more research is needed on this,” Gulur said.
Is ketamine addictive?
Yeah.
“It is a powerful drug that can be easily addicted to,” Gulur said. “This is something that, unfortunately, many people are unaware of. And if it is a drug that can be easily addicted to, extra caution is required when prescribing it to someone who has shown risk factors for addictive behaviors.”
Gulur said he is critical of many ketamine clinics because they may be promising too many benefits from the drug.
“They are taking advantage of a vulnerable population,” she said. “People who are depressed and in chronic pain are one of our most vulnerable groups, and they are looking for some kind of help and solution. I think this needs to be done responsibly, and honestly, people who aren’t thinking about that should be held accountable.”
Gulur also said that doctors need to oversee treatments: “It needs to be part of a larger plan and someone who is monitoring the safety of the various elements of those plans.” “Where is your primary care physician? Where do you have the confidence that your treatment is safe?” she concluded.
