Could Doctors Have Fueled Matthew Perry’s Ketamine Addiction?

Perry had been undergoing ketamine infusion treatment to treat depression and anxiety, but became dependent on the substance.

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Federal prosecutors announced they charged five people with providing actor Matthew Perry with the ketamine that led to his death last October.

Perry’s assistant, two doctors, an acquaintance and an alleged dealer known as the “ketamine queen” were charged Thursday with conspiring to provide the “Friends” actor with ketamine. Perry was receiving ketamine infusions for depression, but allegedly began using it outside of his supervised treatment, sometimes taking it as often as six times a day. He developed what prosecutors described as an “out of control” dependence on the drug.

Ketamine has long been used by medical professionals as an anesthetic, says Allison Bauer, an associate professor of public health and health sciences at Northeastern University. But it’s also been prescribed recently to people with treatment-resistant depression.

Robert Leeman, professor and chair of the Department of Public Health and Health Sciences at Northeastern University, says using ketamine infusions or injections on patients for whom medications like selective serotonin reuptake inhibitors, or SSRIs, don’t work has shown some success.

Bauer, the former director of the Bureau of Substance Addiction Services of the Massachusetts Department of Public Health, says Perry’s death illustrates some of the cons of this treatment.

“It hasn’t been studied that deeply,” Bauer says. “One of the long-term effects (researchers) are worried about is that it can lead to a path of addiction. And since you often wind up with a dual mental health and addiction diagnosis, it’s a dangerous course to take.”

Ketamine treatment for depression is usually given via infusion or injection in a doctor’s office, Bauer says. The drug’s effects only last for several hours. Too much of the drug can cause respiratory and cardiac distress and Leeman says doctors will administer it in a way that users don’t build up too much of a tolerance.

“It’s done in a careful, controlled way, typically in (doctor’s) offices,” says Leeman, whose research focuses on addictive behaviors. “There are some schools of thought about allowing at-home dosing in some cases, but speculatively, Matthew Perry probably wouldn’t have been a candidate for that given his history.”

Prosecutors say Perry’s last treatment was more than a week before his death, meaning the ketamine found in his system was not from that treatment.

While ketamine treatment can be successful, it can also pose a risk in altering the structure of the brain, as well as leading to dependence on the drug, Bauer says. Some studies have shown people using this treatment can also have withdrawal symptoms.

If someone like Perry, who had a history of substance use disorder, uses this treatment, Bauer says it can retrigger their disease. It can also trigger the disease in people without a history of addiction.

“It’s really easy to flip that switch,” Bauer says. “I think we need to shine a deeper light on it and be much more cautious. Would I love there to be more promising, strong treatments for people who suffer from debilitating depression? 100 percent. We have to be careful about not pushing too far ahead of it too soon. This situation doesn’t warrant shutting it down. It warrants a deeper dive to determine if it could be a viable treatment within the correct parameters.”

Perry’s death also highlights how others, including doctors, can play a role in someone’s substance use, adds Leeman. Prosecutors accused Perry’s assistant of injecting him with ketamine, including administering multiple shots on the day the actor died. Dr. Salvatore Plasencia was accused of supplying Perry with the drug. Other celebrities, like Michael Jackson and Prince, also died after receiving drugs from their doctor.

Some people, Leeman says, will help someone with addiction get their substances of choice in the thought that they will be using either way, so it’s better to help them do it safely.

“I don’t know if the assistant had malicious intent,” Leeman says. “But for the medical professionals, there’s a lot of financial incentives here. There are folks that misuse their expertise and their credentials. It seems that they were taking advantage of him and charging him a lot of money for ketamine that they were able to obtain pretty cheaply.”

Bauer says a high profile case likely Perry’s will hopefully lead to more studies examining ketamine treatment and the best way to administer it so patients can experience its benefits with minimal side effects.

“I think we’re going to see stricter controls,” she says. “What we saw with opioids around the increased regulations … my sense is that we’ll see a little bit of that same pattern.”