Will It “Villainize” Ketamine Treatment? – The Hollywood Reporter

You’re sitting in a doctor’s chair, surrounded by nurses. They hook you up to an IV and give you eye shades and headphones. A heart monitor is strapped to your chest. The music is chosen specifically for the experience: the sounds of running water or rhythmic drumming beats composed by well-known trance DJs. You barely feel the needle go in and then, suddenly, the drug is coursing through your veins, rewiring your brain, diverting your neuropathways away from the rut carved by years of depression, anxiety or compulsion. Practitioners pop in and out to check on you during the 50-minute procedure, raising or lowering your dose as appropriate. 

That’s the way ketamine therapy is supposed to work, at least at L.A.’s top-tier ketamine clinics. 

But Matthew Perry obviously had a very different experience.

The 54-year-old former Friends star, who drowned in his hot tub at his home in Pacific Palisades on Oct. 28 after a ketamine overdose, clearly didn’t follow appropriate procedures. Perry, who had a history of addiction issues, had in the past received monitored therapies at one of the slew of ketamine IV centers that have sprung up in L.A. in recent years — as the drug has become increasingly popular in alternative medicine circles. But his final encounter with the drug was clearly much more reckless — and deadly.

“Mr. Perry took more than 10 times the amount of ketamine that we provide in the clinic for therapeutic use,” says Sam Mandel, co-founder and CEO of Ketamine Clinics Los Angeles, one of the first and best-known ketamine clinics in the country. “He did this in combination with an opioid, and on top of that he was alone in a hot tub. There is zero correlation between what happened with Matthew Perry and the therapeutic clinical use of ketamine for mental health.” 

Even so, Perry’s overdose triggered an immediate panic at the licensed ketamine clinics around Los Angeles. Patients started postponing and canceling their treatments as soon as a medical examiner announced Perry’s cause of death on Dec. 15.  

“I was being blown up on that day,” says Megan Haley-Maen, a psychotherapist at Point Health in Southern California, who used ketamine as part of her treatments. She says she received around 50 emails and text messages from patients worried about safety concerns. “My immediate reaction was, ‘This is going to be devastating — it’s going to villainize ketamine.’”

While Perry’s death has predictably spawned a rash of media stories about the dangers of ketamine, the coroner’s report itself makes clear that the dose of ketamine in the actor’s system was much stronger than he could have gotten from regular treatment and even from pharmacies and telemedicine platforms that prescribe online and deliver the drug to patients’ homes. The obvious takeaway from the autopsy is that while Perry was receiving ketamine treatments from a healthcare provider, he was also using ketamine on his own in ways that differ significantly from the alternative therapy for pain and depression. 

The fact is, people almost never die from using ketamine in medical settings unless they mix it with other drugs. And the amount of ketamine Perry had in his system at the time of death — an amount sufficient to put a surgical patient under anesthesia, as the coroner’s report notes — was staggeringly high. The medical examiner ruled that the ketamine in his system could not have been from the infusion therapy, which metabolizes in a matter of hours. Where he acquired such massive amounts of the drug is the subject of an ongoing police investigation. Perry was also taking buprenorphine, an opioid used to treat addiction, whose depressive effects on the central nervous system may have clashed with the ketamine in his system.

People had been speculating about Perry’s shaky behavior well before his death. Stories about his possible drug use were all over the tabloids last winter, shortly after the publication of his memoir, Friends, Lovers, and the Big Terrible Thing, in which he vividly and movingly recounted many of his past battles with addiction, including using ketamine for recreational purposes back in the 1990s. Like “being hit in the head with a giant happy shovel,” he described it in the book.

Indeed, reports of Perry’s 19-month sobriety appear to have been somewhat exaggerated. He was on an antidiabetic medication to lose weight; estrogen for his coronary artery disease; and testosterone to counteract the side effects from the estrogen. (A female friend told investigators the testosterone made Perry “angry and mean.”) In the bedroom of Perry’s assistant, who lived with the actor and discovered him face down in the hot tub, detectives found “multiple open, empty, half-filled medication bottles prescribed to [Perry], as well as over-the-counter medications, vitamins, digestive aids and dishes filled with multiple various loose pills, tablets, caplets, candy and breath mints,” as noted in the autopsy. He was also using nicotine lollipops to quit smoking.

Ironically, in more recent years, ketamine in more controlled doses has been investigated as an auspicious tool in treating drug addiction, as well as numerous other afflictions. Just last May, the New England Journal of Medicine published a study suggesting that ketamine could turn out to be a promising alternative to electro-shock therapy in treating depression. And unlike electro-shock, one of the doctors conducting the study noted, ketamine therapy is “not usually an unpleasant experience for patients.”

For the rapidly growing numbers of health care providers offering the treatment in Los Angeles — charging as much as $3,900 for six sessions, none of which is currently covered by insurance — Perry’s death may prove to be a difficult blow, scaring potential patients away after two years of rapturous press about ketamine’s possible benefits. But practitioners are hopeful that more nuanced coverage of Perry’s death might also create a teachable moment, “informing the public of ketamine’s safe use,” as Haley-Maen puts it.

Joe Schrank, a clinical social worker who frequently consults with Hollywood stars in recovery, also sees Perry’s passing as a tragedy, but not one that necessarily reflects negatively on proper ketamine treatments. Addicts die because they need substances to get outside of themselves, he says. People who drink responsibly don’t die of alcoholism, he says. The same is true of Ketamine.

“Ultimately, the exact cause of Matt Perry’s death doesn’t matter,” he says. “His life was shortened by acute addiction, like millions of other Americans. In my view, he fought hard and had some success and earnestly tried to help others with the same malady. His death shouldn’t be viewed differently than if he succumbed to cancer after a decades-long fight.” 

You’re sitting in a doctor’s chair, surrounded by nurses. They hook you up to an IV and give you eye shades and headphones. A heart monitor is strapped to your chest. The music is chosen specifically for the experience: the sounds of running water or rhythmic drumming beats composed by well-known trance DJs. You barely feel the needle go in and then, suddenly, the drug is coursing through your veins, rewiring your brain, diverting your neuropathways away from the rut carved by years of depression, anxiety or compulsion. Practitioners pop in and out to check on you during the 50-minute procedure, raising or lowering your dose as appropriate. 

That’s the way ketamine therapy is supposed to work, at least at L.A.’s top-tier ketamine clinics. 

But Matthew Perry obviously had a very different experience.

The 54-year-old former Friends star, who drowned in his hot tub at his home in Pacific Palisades on Oct. 28 after a ketamine overdose, clearly didn’t follow appropriate procedures. Perry, who had a history of addiction issues, had in the past received monitored therapies at one of the slew of ketamine IV centers that have sprung up in L.A. in recent years — as the drug has become increasingly popular in alternative medicine circles. But his final encounter with the drug was clearly much more reckless — and deadly.

“Mr. Perry took more than 10 times the amount of ketamine that we provide in the clinic for therapeutic use,” says Sam Mandel, co-founder and CEO of Ketamine Clinics Los Angeles, one of the first and best-known ketamine clinics in the country. “He did this in combination with an opioid, and on top of that he was alone in a hot tub. There is zero correlation between what happened with Matthew Perry and the therapeutic clinical use of ketamine for mental health.” 

Even so, Perry’s overdose triggered an immediate panic at the licensed ketamine clinics around Los Angeles. Patients started postponing and canceling their treatments as soon as a medical examiner announced Perry’s cause of death on Dec. 15.  

“I was being blown up on that day,” says Megan Haley-Maen, a psychotherapist at Point Health in Southern California, who used ketamine as part of her treatments. She says she received around 50 emails and text messages from patients worried about safety concerns. “My immediate reaction was, ‘This is going to be devastating — it’s going to villainize ketamine.’”

While Perry’s death has predictably spawned a rash of media stories about the dangers of ketamine, the coroner’s report itself makes clear that the dose of ketamine in the actor’s system was much stronger than he could have gotten from regular treatment and even from pharmacies and telemedicine platforms that prescribe online and deliver the drug to patients’ homes. The obvious takeaway from the autopsy is that while Perry was receiving ketamine treatments from a healthcare provider, he was also using ketamine on his own in ways that differ significantly from the alternative therapy for pain and depression. 

The fact is, people almost never die from using ketamine in medical settings unless they mix it with other drugs. And the amount of ketamine Perry had in his system at the time of death — an amount sufficient to put a surgical patient under anesthesia, as the coroner’s report notes — was staggeringly high. The medical examiner ruled that the ketamine in his system could not have been from the infusion therapy, which metabolizes in a matter of hours. Where he acquired such massive amounts of the drug is the subject of an ongoing police investigation. Perry was also taking buprenorphine, an opioid used to treat addiction, whose depressive effects on the central nervous system may have clashed with the ketamine in his system.

People had been speculating about Perry’s shaky behavior well before his death. Stories about his possible drug use were all over the tabloids last winter, shortly after the publication of his memoir, Friends, Lovers, and the Big Terrible Thing, in which he vividly and movingly recounted many of his past battles with addiction, including using ketamine for recreational purposes back in the 1990s. Like “being hit in the head with a giant happy shovel,” he described it in the book.

Indeed, reports of Perry’s 19-month sobriety appear to have been somewhat exaggerated. He was on an antidiabetic medication to lose weight; estrogen for his coronary artery disease; and testosterone to counteract the side effects from the estrogen. (A female friend told investigators the testosterone made Perry “angry and mean.”) In the bedroom of Perry’s assistant, who lived with the actor and discovered him face down in the hot tub, detectives found “multiple open, empty, half-filled medication bottles prescribed to [Perry], as well as over-the-counter medications, vitamins, digestive aids and dishes filled with multiple various loose pills, tablets, caplets, candy and breath mints,” as noted in the autopsy. He was also using nicotine lollipops to quit smoking.

Ironically, in more recent years, ketamine in more controlled doses has been investigated as an auspicious tool in treating drug addiction, as well as numerous other afflictions. Just last May, the New England Journal of Medicine published a study suggesting that ketamine could turn out to be a promising alternative to electro-shock therapy in treating depression. And unlike electro-shock, one of the doctors conducting the study noted, ketamine therapy is “not usually an unpleasant experience for patients.”

For the rapidly growing numbers of health care providers offering the treatment in Los Angeles — charging as much as $3,900 for six sessions, none of which is currently covered by insurance — Perry’s death may prove to be a difficult blow, scaring potential patients away after two years of rapturous press about ketamine’s possible benefits. But practitioners are hopeful that more nuanced coverage of Perry’s death might also create a teachable moment, “informing the public of ketamine’s safe use,” as Haley-Maen puts it.

Joe Schrank, a clinical social worker who frequently consults with Hollywood stars in recovery, also sees Perry’s passing as a tragedy, but not one that necessarily reflects negatively on proper ketamine treatments. Addicts die because they need substances to get outside of themselves, he says. People who drink responsibly don’t die of alcoholism, he says. The same is true of Ketamine.

“Ultimately, the exact cause of Matt Perry’s death doesn’t matter,” he says. “His life was shortened by acute addiction, like millions of other Americans. In my view, he fought hard and had some success and earnestly tried to help others with the same malady. His death shouldn’t be viewed differently than if he succumbed to cancer after a decades-long fight.”