What you need to know about ketamine


An autopsy report released by the Los Angeles County medical examiner on Friday 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 due to to “acute effects”. 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.

Perry had publicly acknowledged his long struggle with alcohol and drug use, but the report said he had been sober for 19 months and little was known about his relationship with ketamine.

Ketamine is a short-acting injectable dissociative anesthetic that can have hallucinogenic effects at certain doses. It distorts perceptions of sight and sound and makes users feel detached from pain and their surroundings.

Developed as a battlefield anesthetic in the 1960s, ketamine has been legal since 1970 for use in both people and animals. It is frequently used as an anesthetic in children, especially in the developing world.

But the psychiatric use of ketamine is not yet approved or regulated, 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 that is marketed as esketamine.

Ketamine has potential for abuse, which can lead to moderate to low physical dependence or high psychological dependence, but experts consider it a safe medication.

Recreational users often inhale the drug in powder form or administer it intranasally via aerosol.

“People should not be afraid to use ketamine if prescribed by their doctor and administered correctly in a health care setting,” said Dr. Gerard Sanacora, director of the Yale Depression Research Program and co-director of Yale New Hospital. Haven. Interventional Psychiatry Service.

Ketamine is rarely fatal, but an overdose can cause unconsciousness and dangerously slow breathing, according to the Drug Enforcement Administration (DEA). The amount of ketamine found in Mr. Perry's system was extremely high, comparable to an anesthetic dose, the medical examiner's office wrote.

Side effects such as increased blood pressure and paranoia are rare and usually occur at very high doses. Frequent users of the drug may develop bladder problems.

In October, the FDA issued a warning about the dangers of using compounded versions of ketamine. Compounded medications are those that have been modified or adapted in a laboratory for the specific needs of an individual patient.

The agency, citing reports of adverse incidents, warned that unsupervised use of compounded ketamine increased the risk of dangerous psychiatric reactions and health problems such as increased blood pressure, respiratory depression and urinary tract problems that can lead to incontinence.

Matthew Perry had more ketamine in his system than the amount used for a typical infusion, the autopsy report showed.Credit…Carlo Allegri/Reuters

Dr. Steven Radowitz, medical director of Nushama, a ketamine clinic in New York, said patients must undergo a complete medical and psychiatric examination “to ensure they are suitable for treatment.”

At Nushama and other clinics, doses are administered at “subanesthetic” levels so that patients remain conscious during their therapy sessions, Dr. Radowitz said.

Perry had been receiving medically supervised ketamine infusion therapy for depression and anxiety, and had received an infusion a week and a half before he died, according to the autopsy report. The medical examiner's office determined the treatment was unrelated to her death because the drug remains in her system for only a few hours.

Although the report does not say so, it suggests that Perry was using ketamine at home at the time of his death.

Law enforcement authorities did not find ketamine in his home, the medical examiner said.

The report does not detail the exact sequence of events that led to Mr. Perry's death, but cites three contributing factors: drowning, coronary artery disease and buprenorphine, a prescription medication he was taking to treat opioid addiction.

“With the high levels of ketamine found in their postmortem blood samples, the main lethal effects would be both cardiovascular overstimulation and respiratory depression,” the report said.

At high doses, ketamine can cause dangerous changes in blood pressure that can be particularly harmful to people with cardiovascular disease.

The sedative effects of ketamine could have been aggravated by the buprenorphine Mr. Perry was taking.

Dr. Sanacora of Yale University said the large number of risk factors made it difficult to determine what caused 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 potential things that could have happened,” he said. “The most important takeaway is that ketamine is not a medication that should be taken at home.”

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