What you need to know about ketamine
An autopsy report released Friday by the Los Angeles County medical examiner said the death of “Friends” actor Matthew Perry, who was found face down and unconscious in a hot tub at his home on Oct. 28, was the result of the ‘acute consequences’. of ketamine, an anesthetic with psychedelic properties.
Ketamine has become increasingly popular as a therapy for treatment-resistant depression and other mental health problems. It is also used recreationally.
Mr Perry had publicly acknowledged his long battle with alcohol and drug abuse, but the report said he had been sober for 19 months and little was known about his relationship with ketamine.
What is ketamine and is it legal?
Ketamine is an injectable, short-acting dissociative anesthetic that can produce hallucinogenic effects at certain doses. It distorts the perception of sight and sound and makes users feel disconnected from the pain and their surroundings.
Ketamine was developed in the 1960s as a battlefield anesthetic and has been legal for use in both humans and animals since 1970. It is often used as an anesthetic for children, especially in the developing world.
But the psychiatric use of ketamine remains unapproved and unregulated, although it is increasingly used off-label to treat depression, suicidal ideation and chronic pain.
In 2019, the Food and Drug Administration approved a nasal spray version of ketamine for treatment-resistant depression, marketed as esketamine.
Ketamine has the potential for abuse, which can lead to moderate or low physical dependence or high psychological dependence, but experts consider it a safe drug.
Those who use it recreationally often snort the drug in powder form or administer it intranasally via a spray.
“People should not be afraid to use ketamine if it is prescribed by their doctor and administered appropriately in a health care setting,” said Dr. Gerard Sanacora, director of the Yale Depression Research Program and co-director of the Yale New Haven Hospital. Interventional Psychiatry Service.
Can ketamine be fatal?
Ketamine is rarely fatal, but an overdose can cause unconsciousness and dangerously slowed breathing, the paper said Drug Enforcement Administration. The amount of ketamine found in Mr. Perry’s system was extremely high, comparable to a dose of narcotics, the medical examiner’s office wrote.
Side effects such as increased blood pressure and paranoia are rare and usually occur with: very high doses. Frequent users of the drug may experience bladder problems.
The FDA issued a warning in October about the dangers of using compounded versions of ketamine. Compounded medicines are medicines that have been modified or tailor-made in a laboratory for the specific needs of an individual patient.
The agency warned, based on adverse incident reports, that unsupervised use of compounded ketamine increases the risk of dangerous psychiatric reactions and health problems such as elevated blood pressure, respiratory depression and urinary tract problems that can lead to incontinence.
Dr. Steven Radowitz, chief physician at Nushama, a ketamine clinic in New York, said patients should undergo a full medical and psychiatric screening “to ensure they are suitable for treatment.”
At Nushama and other clinics, doses are administered at “sub-anesthetic” levels so that patients remain conscious during their therapeutic journey, said Dr. Radowitz.
What is known about Mr. Perry’s ketamine use?
Mr. Perry had been undergoing medically supervised IV ketamine therapy for depression and anxiety, and according to the autopsy report, he had been given an IV a week and a half before his death. The medical examiner’s office determined that the treatment was not related to his death because the drug only stays in the system for a few hours.
Although the report does not state this, it suggests that Mr Perry was using ketamine at home at the time of his death.
Law enforcement authorities found no ketamine at his home, the medical examiner said.
The report does not detail the exact sequence of events that led to Mr. Perry’s death, but does list three contributing factors: drowning, coronary artery disease and buprenorphine, a prescription drug he was taking to treat opioid addiction.
“At the high levels of ketamine found in his post-mortem blood samples, the main lethal effects would be due to both cardiovascular overstimulation and respiratory depression,” the report said.
At high doses, ketamine can cause dangerous changes blood pressure which can be especially harmful to people with cardiovascular disease.
The sedative effects of ketamine could have been exacerbated by the buprenorphine Mr. Perry was taking.
Dr. Sanacora of Yale University said the plethora of risk factors makes it difficult to determine what caused Mr. Perry’s death.
“I’m not a coroner or a forensic pathologist, but he had a lot of risk factors and there are a lot of possible things that could have happened,” he said. “The most important conclusion is that ketamine is not a medicine that you can take at home.”