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Statement by Phil Wolfson MD about Matthew Perry’s Unfortunate Demise

Addendum 12/21/2023:

Some new info has surfaced as is expected. It was a hot tub immersion, not a swimming pool, making it much  less likely that there was anything deliberately suicidal, save for the risks in getting that smashed on k and other substances, and becoming unconscious in the tub due to sedation.  This is as would be expected with what it appears he most likely put in his nose. The autopsy report has this singularity: He had high levels of ketamine in his blood, and likely lapsed into unconsciousness and then went under the water, the autopsy report said.This clarification of the tragedy of misuse and its consequences leaves us with the same tragic view– as does the imperative to not get into the waters after you blitz yourself with whatever blitz you may choose—not restricted to ketamine.Clinical and responsible use of ketamine remains both safe and beneficial. Ketamine abuse is an issue as is self-destructive misuse of any psychedelic medicine all of which have some possibility for dependency in varying degrees. Exploration of the NIDA data for ketamine reveals the absence of deaths due directly to ketamine with its wide margin of physiological safety. Emergency room visits for ketamine are in the same percentages as for other psychedelics. We have only to remember the Rave scenes, and the deaths attributable otherwise to MDMA due to aberrant behavior or polypharmacy. Which is not to tear at MDMA but to remember we inhabit world in which people make bad judgements, get in trouble, have unsuccessful interventions, and seek oblivion and relief. There are the 103,0000 deaths from opioid overdoses in the US to pay attention to. So many beloved people are lost and get lost. Let’s help each other and tell the truths to each other. Ignorance is not bliss.  It is ignorance.

Matthew Perry died by drowning. Ketamine was found to be present at autopsy at high levels characterized as ‘anesthetic levels’.  Buprenorphine was also present, and he had significant coronary artery disease. He was open publicly about his long struggles with alcohol and drug dependence.  The presence of buprenorphine indicates he was under treatment for opioid dependence.

Apparently, Perry had been receiving intravenous ketamine treatment in a clinic and appeared to have stopped a month or so ago. The reasons for this are unclear. Ketamine has a more than two decade history for treating alcohol and drug dependence with some degree of success for some people. It is known to reduce the quantity of opioids needed for the same mental effect—a partial reduction. As with all treatments for dependency, continuation of treatment with and without ketamine is a necessity to prevent relapses.

Any sedating drug is incompatible with swimming and bathing. It is not related to whether it is ketamine, Xanax, Valium, or other substances that suppress consciousness.  Taking sedating drugs that produce sleep induction in water deep enough to drown in is a definite no-no.

Perry most likely had procured ketamine without a prescription as a powder and insufflated a great amount. An anesthetic level means simply that you are anesthetized and will not be able to deal consciously with circumstances. Ketamine takes a bit of time to have its effect—seconds to minutes—sufficient time to make a mistake and then subsequently become unconscious.

Without much doubt Perry had obtained ketamine on the illegal market. Had he been prescribed lozenges from one of the many web distributors, he would have had to hold many lozenges for many minutes to have an effect, and it would have been extremely difficult  to have taken the amount of lozenges representing the autopsy levels into the pool as his ability to breathe through his mouth would have been difficult.  And most likely, he would have had to lie down–and not in water. Had a legal prescriber provided the ketamine to Perry, it would have been both criminal and a gross malpractice.

Ketamine produces transient elevation of blood pressure, generally in the range of exercise elevations of heart rate and blood pressure. We do not know the condition of his coronary arteries and if ketamine’s transient effects contributed to his death. It is doubtful–and apparently, the autopsy did not reveal a myocardial infarction. It is also not clear what physical shape Perry was in and had he had a period of drug use that might have reduced his fitness.

This tragedy and others somewhat like it become lore that discredits the safety and profound potentiality of ketamine. All substances have abuse potential and are abused. Benzodiazepines (like Valium), antidepressants, sedatives, medicines used for  muscle relaxation, opiates, cocaine, meth, aspirin, acetaminophen, alcohol, psychedelics, etc. all have their aficionados and different forms of dependency and withdrawal—physical, psychological and spiritual. Ketamine has its own specificity.

In clinical practice, ketamine dependency and abuse are rare.  Ketamine’s benefits are legion and mostly extraordinary. There is no benefit to ketamine bashing.  Sensationalism and misattribution only serve to perpetuate ignorance and repression.

The conclusion is that Matthew Perry drowned, and he and we did not have sufficient capacities to help him with his demons. While it is not clear that he suicided, his action of taking ketamine as a substance known to him  for its effects raises the question for us—did he just have enough of life?

                             –Phil Wolfson MD  The Ketamine Papers, etc.

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