Matthew Perry's Life and Death
A look at Matthew Perry's life, death, and questions about recovery.
News of Matthew Perry’s autoposy and toxicology broke late Friday night. The headlines and coverage felt confusing. And the disconnect largely stemmed from the way journalists interpreted the medical examiner’s report. (Medical examiner’s stick to a very rigid and obscure way of writing up the results of their autoposies and investigations).
Before I go into the details of Perry’s autopsy, I think it’s worth lingering a bit more on Perry’s life, and the way he very publicly owned his addiction. And before I get to that, there’s even more bizarre coverage about a so-called friend of Perry’s claiming: “He lied to everyone about being clean. He never was. It is very sad. You know, the biggest lie he told was probably to himself.”
Who knows where this kind of garbage comes from. But I feel like such a stupd thing to say about someone’s recovery could be traced back to the fact that Perry was taking buprenorphine for his opioid addiction. And in the Los Angeles, woo-woo, Goop-adjacent recovery scene, where parents refuse to vaccinate their children, taking buprenorphine for opioid addiction is certainly not considered “clean and sober,” because buprenorphine is itself an opioid. In this more militant idea of recovery, taking ketamine prescribed by a doctor, to try and find some semblance of relief from depression, is probably also considered a “relapse.”
I don’t find it at all fruitful to question Perry’s recovery status. Whatever the word meant to him is it what it meant.
Perry had written a memoir about his long struggle with addiction pretty recently. He once said he was so strung out on alcohol and pills that there were entire seasons of “Friends” that he couldn't remember filming. In the Prologue to his book, Perry ominously wrote, “I should be dead.” He described the pain of addiction as “The Platonic Ideal of Pain.”
Perry’s very public reckoning with addiction and championing recovery took actual courage. Perry traced his addiction back to growing up in a fractured family that left him to fend for himself. He spoke of “the void” that so many of us with addiction feel. A void that fame and a $1 million per week paycheck couldn’t fill. Perry wrote about the loneliness he felt, but also about the joy and friendship and connection he found in recovery.
What I admired about Matthew Perry is that he violated the principle of anonymity, considered by many “in the rooms” to be sacrosanct, on the grounds that being too hush-hush fuels stigma and prejudice. That by being open, he could maybe help others.
Cause of Perry’s Death: Drugs and Drowning
Once the autopsy was made public, headlines blasted across the world that ketamine killed Matthew Perry. Scanning the news, the takeaway was that he died from “the acute effects of ketamine.” Perry was found unresponsive in a hot tub at his home in Los Angeles on Oct. 28. His assistant arrived at his place after running errands at around 4 p.m. on a Saturday. Perry was floating face down, already dead.
Many interpreted the report to mean that Perry had died of a ketamine overdose. But that’s not exactly what the report says. Reports of Perry’s death listed additional, contributing factors: drowning, coronary artery disease, and the effects of buprenorphine (an opioid). These reports list the factors in order of importance.
Let’s work backwards: At therapeutic doses and in a person tolerant to opioids, buprenorphine has little to no effect on one’s vital functions. In an interview with VICE, Dr. Ryan Marino said, “People function completely normally [on buprenorphine]. It does not affect their respiratory status. It does not affect their mental status. Especially if he had been on it for a long time.” That’s probably why buprenorphine was listed last. Medical examiners always report every substance found in a person’s system at the time of their death, especially opioids and sedatives, even though it’s unlikely buprenorphine played much, if any, of a role.
I apologize in advance for the following digression: I was curious as to what kind of interaction buprenorphine and ketamine have. I found an interesting set of case studies where people addicted to fentanyl started taking buprenorphine treatment, and the buprenorphine triggered a percipitated opioid withdrawal. For those of you who don’t know, if you take buprenorphine with a full-agonist like fentanyl on board, you will probably feel the closest thing there is to hell on earth. The stuff nightmares are made of. A withdrawal so disgustingly sickening that it’ll will make you want to rip off your skin and jump into a burning fire.
In these case studies, people stuck in a buprenorphine-induced opioid withdrawal were given ketamine and many of them felt instantaneously better. People went from the sickest they’ve ever felt in their life to walking around the hospital with a smile on their face. Anyways, these reports find that buprenorphine and ketamine are not only safe to mix, but that the combination might actually be working wonders on some people.
After buprenoprhine, the Los Angeles County Medical Examiner’s report listed coronary artery disease. That means not enough blood, oxygen, and nutrients make it to the heart muscle, often due to cholesterol deposits, or plaque, in arteries. If you’ve been to a spa or hotel, you’ve probably seen signs warning people with heart disease and other medical conditions to limit their time spent in hot tubs. Hot tubs can make you feel drowsy. They can lower blood pressure and increase your heart rate. At 54, Perry wasn’t very healthy. He had had numerous conditions and surgeries for being relatively young. A hot tub plus his heart condition could’ve actually been a lot on him.
Which gets us to the next two causes: ketamine and drowning is where things get a little messy.
The medical examiner’s report found Perry’s blood contained 3,271 nanograms per milliliter of ketamine. That is a high dose to be using at home in an unmonitored setting. That dose, experts say, is within the range of someone undergoing sedation for a medical procedure. That dose, to be sure, is not fatal.
Ketamine is a dissociative analgesic and anesthetic, which makes it useful for anaesthesia and surgical procedures. That dissociative state can feel you’re detatched from bodily sensations and your environment. That’s why ketamine probably helps somebody in the throes of an opioid withdrawal. Sedated on ketamine, a person might feel immobile, like they cannot exert control over their body. That is a really bad thing to happen while you’re floating in a pool or sitting in a hot tub. That is probably what happened to Perry.
Dr. Andrew Stolbach, an emergency physician and medical toxicologist at Johns Hopkins—quoted in the AP and in VICE on Perry’s autoposy—said the amount of ketamine detected “would be enough to make him lose consciousness and lose his posture and his ability to keep himself above the water.” As Perry lapsed into unconsciousness, he submerged in the pool and drowned.
Stolbach also noted that had Perry not been in a pool or hot tub, it’s unlikely that that dose of ketamine would be fatal. “The tragic lesson here is that it’s risky to use sedative drugs when you’re in water, especially when you are alone,” Stolbach said.
But that assessment—the same one also summarized in the medical examiner’s report— hasn’t stopped people from projecting their own agendas and wishes on Perry’s death. Again, the hard-core Narcotics Anonymous and total abstinence crowd exclaimed Perry’s death was a ketamine overdose, even though overdoses on ketamine are quite rare. And in Perry’s case, it was clearly a mix of sedatives and drowning.
But that more militant recovery crowd still says: See! This is what happens when ‘addicts’ take ketamine. That Perry’s idea to try ketamine treatment violated the rules of recovery. Others who are more wary of the recent proliferation of ketamine infusion therapy didn’t waste time in arguing that Perry’s death illustrates the need for much tighter regulation of these clinics. Again, that is dubious given the facts.
Perry was indeed receiving ketamine infusions for depression. Some people report feeling a weight of relief rapidly after using ketamine. For people who are acutely suicidal, ketamine is one of very few things that can help prevent the worst outcome. So, no. Ketamine infusions did not his cause Perry’s death. His last ketamine infusion ocurred over a week before his death. Those infusions take place in monitored settings under the care of medical professionals. The ketamine Perry used at his home was not part of any ketamine therapy program. It’s not clear where that ketamine came from, or which form the it came in, or the route of adminstration. It also wouldn’t be the frist time a very wealthy celebrity had access to whatever drugs he wanted, whenever he wanted.
Everyone has something they want you to takeaway from Perry’s death. Some say it’s about the evils of drugs. How no one who has a history of addiction should ever, under any circumstances, ever be using drugs. Some have used Perry’s death to say this is yet another example of people looking for a quick fix, seeking a drug to solve their pain, to fill the void, and that’s never going to work.
I feel compelled to find something else to say. Of course, had it not been for the ketamine that day, and had it not been for the hot tub, Perry probably would still be alive. He was just 54 years old. He had so much life ahead of him.
But I’m thinking less about the drugs and more about the topic Perry wrote about extensively: the isolation, the void, feeling like you’re alone even when you’re surrounded by love and connection. And in Perry’s case, being adored by fans arouond the world. I thought about that final day of Perry’s life. He played pickleball with friends at 11 a.m. His assistant left the house to run errands at around 1:30 p.m. and returned to Perry’s home at about 4 p.m. By then Perry was already gone. I’m left thinking about that window of time: 1:30 p.m. to 4 p.m. when Perry was home alone.
What was he thinking?
I had the same reaction. He drowned. Ketamine infusions are used by lots of people in various situations. I was so annoyed by the coverage.
Thank you for linking to the AP article to which I contributed reporting.
I, too, was struck by what you say here: "It also wouldn’t be the first time a very wealthy celebrity had access to whatever drugs he wanted, whenever he wanted."
When medical professionals are involved, it's called VIP Syndrome.
According to the autopsy report, Perry was prescribed tamoxifen to lose weight and testosterone shots. They found "Tirzepaide injectables" in the refrigerator, which was probably a typo for tirzepatide, better known as Mounjaro, a new diabetes drug prescribed off label of weight loss.