Matthew Perry’s ketamine OD raises questions about its use for mental health problems

The death of actor Matthew Perry in October as a result of ketamine has sparked new concerns and scrutiny that has focused on the drug’s illicit use.

Ketamine is used as an anesthetic in hospitals, where it has a long history of safe use. It has also been abused as a drug. More recently, it has shown promise as an alternative treatment for unusually severe mental illnesses, including depression, anxiety, post-traumatic stress disorder, and obsessive-compulsive disorder.

Although it is not FDA-approved for psychiatric conditions, doctors can legally prescribe it as an exceptional treatment.

Meanwhile, a pandemic-era exemption allows doctors to prescribe ketamine via telemedicine without an in-person exam. Some patients receive ketamine in clinics or at home with a therapist present, and some use it unsupervised at home.

Perry battled alcohol and drug addiction throughout his adulthood. He spoke openly about his struggles, detailing his dozens of treatment sessions​​​​​​ and the profound impact addiction had on his health.

Perry, 54, had received ketamine infusions legally from a clinic to treat depression. However, an autopsy determined that the ketamine found in his body after his death on October 28 could not have been from his last known treatment because too much time had passed, according to The New York Times, which reviewed the autopsy report.

Although a Los Angeles doctor ruled that ketamine was the main cause of her accidental drowning in the hot tub, other factors included heart disease and buprenorphine, commonly used to treat opioid addiction and sometimes as a pain reliever. According to the doctor, the ketamine would have increased his heart rate and slowed his breathing.

In October, several weeks before Perry’s death, the FDA issued a warning about ketamine, citing risks such as abuse, high blood pressure and bladder problems, as well as risks from using it at home without a health care provider.

The U.S. Drug Enforcement Administration was already working on new rules that would limit the use of telemedicine to prescribe drugs, including ketamine.

Deaths like Perry’s are considered rare. Still, it has sparked new discussion and concern. The American Society of Ketamine Physicians, Psychotherapists and Physicians called the star’s death a wake-up call for ketamine practitioners and the broader medical community to set clear and consistent safeguards guided by real data and medicine, the Washington Post reported. The nonprofit group said it is drafting guidelines for using ketamine at home.

According to MedPage Today, psychiatrist Drew Ramsey of Spruce Mental Health in Jackson, Wyoming, wrote on social media: In clinical settings, ketamine has a known safety profile. That doesn’t mean it’s safe. Ramsey also cited celebrity, substance abuse disorders, personality pathology, psychedelic medicine and concierge medicine as possible factors in Perry’s death.

Adam Kaplin, chief scientific officer of Mira Pharmaceuticals, cited by The Washington Post, believes that ketamine has great potential to help people with psychiatric illnesses. Perry’s death shows that it is very potentially dangerous to allow patients to use this at home.

At the same time, various start-up companies are trying to increase the intake of ketamine for people suffering from difficult-to-treat depression and other mental health problems.

One point of contention centers on those who believe the drug should only be used in the presence of a trained therapist, and others who say the treatment is prohibitive for many patients if they can’t use it at home, according to the Post.

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