Matthew Perry Drowned While On Ketamine: Medical Examiner

“Friends” star Matthew Perry died after taking a large dose of ketamine and drowning, according to a Los Angeles County Medical Examiner’s report released Friday. 

Perry, who drowned in a hot tub at his L.A. home in October, was 54. The report said “the acute effects of ketamine” was the cause of death and listed drowning, coronary artery disease, and buprenorphine—an opioid medication used to treat opioid addiction as contributing factors. The death was accidental. 

Perry was found floating face down unresponsive. 

Perry had high levels of ketamine in his blood when he died, the report said.

“The main lethal effects would be from both cardiovascular overstimulation and respiratory depression,” according to the medical examiner. 

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“Drowning contributes due to the likelihood of submersion into the pool as he lapsed into unconsciousness.” The report said coronary artery disease exacerbated the ketamine’s effects on his heart—but toxicologists told VICE News there was no evidence of heart attack. He did not have toxic levels of buprenorphine in his system, but it contributed because of the “additive respiratory effects when present with high levels of ketamine,” the report said. 

Ketamine is a dissociative anesthetic that is also used recreationally and off-label to treat mental health problems. 

Perry had 3,271 nanograms per milliliter of ketamine in his blood, the report said, noting that when used for general anesthesia, levels range from 1,000-6,000 nanograms per milliliter. 

“This is roughly within the range of something that would sedate somebody enough for a surgical procedure” said Dr. Andrew Stolbach, an emergency physician and medical toxicologist at Johns Hopkins Hospital. 

Stolbach said it’s unlikely Perry would have died if he was not in a body of water. 

“It's really dangerous to use sedative drugs in a pool, especially alone, or a bathtub.” 

Perry was receiving ketamine infusion therapy for depression and anxiety, but his last known treatment was one and a half weeks before his death, so the ketamine from that treatment could not have remained in his system. 

While people can use ketamine compulsively, it doesn’t cause physical withdrawal symptoms or a comedown. It can cause bladder issues for people who use it frequently, but deaths are relatively rare. 

A 2021 study published in the Journal of Psychopharmacology found in England, there are around 30 deaths linked to ketamine a year, a number that’s risen from around 5 per year between 1997-2005. Most deaths involved other drugs. 

Dr. Ryan Marino, medical director of toxicology and addiction medicine at University Hospitals in Cleveland, said the ketamine did not stop Perry from breathing. He said the drug has “an incredibly large safety window but when someone's dissociated when someone's so out of it that they can't even keep themselves up in a pool, that's where problems happen.” 

Buprenorphine is a partial opioid agonist, meaning it doesn’t fully activate the opioid receptors and doesn’t cause full respiratory depression. 

“At a therapeutic dose, people function completely normally. It does not affect their respiratory status. It does not affect their mental status. Especially if he had been on it for a long time,” Marino added. 

Ketamine-assisted therapy has exploded in the last few years, with hundreds of clinics popping up across the country and some services providing take-home doses. 

Marino said Perry’s death could add to the controversy around giving people ketamine to take in unsupervised settings.