• Sun. May 19th, 2024

Matthew Perry’s ketamine overdose should be a lesson in expanded use of the dangerous drug

Matthew Perry's ketamine overdose should be a lesson in expanded use of the dangerous drug

Now that the autopsy report has revealed that beloved actor Matthew Perry died of a large ketamine overdose, from an amount that is only intended for use during anesthesia, it is time to closely examine the drug and its storied past.

In Perry’s case, according to the autopsy report, ketamine caused either an acute heart issue (he had underlying heart disease) such as an arrhythmia and/or a respiratory arrest followed by submersion face down in the hot tub.

Perry was receiving ketamine regularly by intravenous injection to treat his longtime depression and anxiety, but according to the coroner, hadn’t received an intravenous administration in over a week, and ketamine only lasts for three or four hours.

But Dr. Michael Baden, world-renowned forensic pathologist and former NYC chief medical examiner, told me he agrees with the autopsy conclusion that Perry died from ketamine and pointed out that since there was ketamine found in his stomach he most likely took it orally.

Addiction history

Perry became addicted to Vicodin following a 1997 jet ski accident and ended up with a burst colon in 2019 as a result of his opioid use.

Severe depression and alcohol use disorder accompanied his drug use.

Perry was very open about his addiction, and wrote about it in his memoir last year, “I’m Grateful to Be Alive.” It is tragic that the very drug he was trying to use to save himself succeeded in killing him, and it is a warning to all of us about the risks of self-medicating with ­potent drugs.

Too often, drugs we use to replace other drugs are as dangerous or more so than the originals.

In the late 19th century, Bayer developed heroin as a pain reliever and cough suppressant and to help cure Civil War wounded of “soldier sickness” (morphine addiction), only to find that heroin was far more potent and dangerous.

The same may be said for fentanyl, which was developed as an anesthetic in the 1960s and then to treat cancer pain, only to find that it was far more potent than the treatments it was replacing and ripe for illicit use.

Ketamine was initially utilized as an anesthetic for use in horses in the 1960s, and according to Baden, when the horses appeared to hallucinate, this led to it becoming a popular street drug for humans at the same time that anesthesiologists began to use it during surgery.

The rapid expansion for use for depression and pain has not been sanctioned by the FDA, which has approved an inhaled form of a related drug (esketamine) since 2019 for severe depression, but advises that it only be used in very carefully controlled settings.

Rapid rise

The problem with ketamine (oral, lozenge, inhaled) overuse and over-prescription off-label (without FDA approval) has expanded dramatically in recent years thanks largely to telemedicine and online prescribing.

According to EPIC Research, which examined a database of more than 125 million patients, ketamine prescriptions have soared more than 500 percent since 2017, with only 5 percent of the reason being depression in 2017, growing to 28 percent due to depression in 2022 with an additional 19 percent reportedly due to anxiety.

Pain continues to be the reason for the prescription over one- third of the time, but the use to replace opioids with ketamine has also not been well studied and carries additional risks, especially at higher doses.

As far as depression is concerned, ketamine has only been studied and found to be effective for use in severe depression, where the alternative a patient is facing might be electro-convulsive therapy and hospitalization.

The mind/body dissociation a patient experiences with ketamine can help pull them out of a severe downhill spiral.

Ketamine’s rapid expansion to regular use for lesser forms of depression and anxiety as well as pain management is disturbing and reckless.

Many studies are ongoing, but they need to be completed and assessed.

I am certain that Matthew Perry would want us to learn this lesson from his tragic death.

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