How Matthew Perry’s death exposed Hollywood’s ketamine drug network

Before he was found dead in the hot tub of his Los Angeles home last year, Matthew Perry, one of the actors from the popular Friends series, uttered the words that would lead to his death: “Hit me up big time.”

This was a large dose of ketamine, court documents would later reveal.

It was Perry’s third injection of the day of the addictive anesthetic and hallucinogen that has become popular for its over-the-counter use in treating depression and anxiety.

Hours after that lethal dose, the “Friends” actor was found face down in a hot tub on October 28, 2023.

He was declared dead at the scene by paramedics, and the coroner determined that the cause of death was ketamine.

Following a police investigation, five people were charged in court over Perry’s death.

Court documents shed light on Perry’s decades-long battle with drug addiction and Hollywood’s ketamine drug network.

Doctors and experts say ketamine’s popularity in recent years has been driven by ketamine clinics and online services that offer easy prescription access to the drug, as well as a burgeoning illicit drug market.

Dr. David Mahjoubi, president of the American Board of Ketamine Physicians, told the BBC that ketamine is easy to obtain:

“It’s very easy to get, whether illegally or with a prescription. There are celebrities who get prescriptions from me. It’s not difficult at all.”

Underground Network

Federal authorities said the investigation into Perry’s death uncovered a “vast underground criminal network” of drug suppliers who distributed large quantities of ketamine in Los Angeles.

Court documents focus on Perry’s final months, detailing the transition from treatment at a ketamine clinic — where a doctor administered the drug for depression and anxiety and monitored its side effects — to an addiction that led him to “unscrupulous doctors” and a network of street dealers.

Perry has been open about his addiction issues, dating back decades, even to his time playing Chandler Bing on “Friends.”

Whenever a drug entered his life, he immediately became addicted.

Ancak Friends, Lovers, and the Big Terrible Thing At the end of his memoir, he said he had recovered from addiction, and one woman told investigators at the medical examiner’s office that she believed he had been sober for 19 months.

Somewhere during this time, he began receiving ketamine infusion therapy.

Experts say Perry’s history of addiction contributed to his rapid descent into drugs.

The investigation revealed that in the approximately two-month period before his death, Perry purchased dozens of vials of ketamine for thousands of dollars.

For three days before his death, his assistant had been giving him ketamine injections at least six times a day.

Five people were arrested as part of the investigation; three of them pleaded guilty to conspiracy.

The men face a total of 23 charges in connection with Perry’s death.

‘Yes-men’ who approve of everything

A number of doctors and experts the BBC spoke to for the report spoke of the toxic relationship between celebrities and medicine.

“VIP treatment is often not the best treatment. Doctors are human, and although they take the Hippocratic Oath, not everyone abides by it,” says Gerard Sanacora, MD, director of the Depression Research Program at Yale University.

Doctors can “lose perspective when they have a VIP patient,” says Sanacora, and may be tempted by invitations to parties or promises of donations to research programs or charities.

Dr. Mahjoubi, who runs two ketamine clinics in California, including one in Los Angeles, also says it can be difficult to maintain normal boundaries when celebrities are your patients.

He explains that he treated a celebrity whose name he did not disclose and gave him his mobile phone number for emergencies, but the patient “continuously asked for something, demanded that his prescription be refilled”, regardless of Saturday or Sunday.

“I told him, ‘Look, please email me anything medically relevant,’ and I blocked him,” Dr. Mahjoubi said.

He also notes that ketamine has become popular among celebrities because it is thought to be safer than drugs like cocaine, which is often laced with deadly substances like fentanyl.

Another doctor, who runs several pain management centers in the Los Angeles area, calls the spread of ketamine treatments the new “Wild West.”

The doctor, who asked to remain anonymous, detailed the popularity of ketamine and the tricky relationships he has witnessed between doctors and some celebrities.

According to the doctor’s statement, everyone wants to be “the doctor of the stars.”

Some go so far as to offer free treatment in the hope that celebrity patients will post about their treatments on social media, or close their clinic or office for exclusive access.

“There are celebrities who are passed around from doctor to doctor and fought over,” he added, describing it as both a “strange relationship” and a disturbing business model.

According to him, “Most of these stars are used to being told ‘yes.’ If you don’t, they go to someone else who will give them what they want.”

Surrounding yourself with “yes-sayers” can have life-changing consequences, said Garrett Braukman, executive director of Alta Centers, a rehab and detox treatment center in Hollywood. About 20% to 30% of his patients work in the film industry.

He notes that he has seen an increase in ketamine addiction, but that it has not outpaced commonly abused substances like alcohol, cocaine, and opioids.

According to Braukman, “People often turn to art because of things they’ve been through—oftentimes it’s trauma. Add to that the very ‘normalized’ drug culture of Los Angeles and the access of celebrities, and you have the perfect recipe for addiction.”

The beginning of a new prescription drug epidemic?

A simple Google search for “ketamine prescription” turns up ads for online companies promoting the benefits of “psychedelic therapy” to treat a range of illnesses, from depression and anxiety to Lyme disease and chronic pain; some even offer a subscription for the drug for as little as $100 a month.

But the problem is that ketamine is not approved to treat these diseases.

The U.S. Food and Drug Administration (FDA) approves ketamine for general anesthesia only under the supervision of a physician.

In 2019, the FDA approved a nasal spray medication made from ketamine, allowing it to be used to treat depression as long as the medication is combined with additional therapy and administered under the direct supervision of a doctor. It also requires that patients remain under medical supervision for two hours after taking the dose to prevent potential side effects such as hallucinations, feelings of detachment from reality, and increased blood pressure.

But experts say these online clinics are exploiting a gray area in regulations to market off-label prescriptions of ketamine directly to consumers.

While FDA advertising regulations restrict drug companies that “manufacture, distribute, or package” pharmaceuticals, they do not restrict new ventures such as online “wellness” clinics.

“It’s a very tricky thing, it’s like a loophole,” according to Dr. Sanacora.

Two weeks before Perry’s death, the FDA warned consumers about unspecified uses of ketamine, saying the lack of oversight “could put patients at risk.”

Doctors and experts say the market has boomed during the pandemic, with online healthcare services, clinics and home care becoming more widespread.

Speaking to the BBC on condition of anonymity, the doctor said some of these companies were structured in a way that “didn’t want people to get better” but instead kept them hooked on prescriptions to continue making money. “This has gotten out of control.”

Dr. Sanacora, who studies and researches how ketamine can be used to treat depression, states that there is a lot of evidence for the effectiveness of the drug and that drug trials testing the benefits of ketamine treatment for treatment-resistant depression are ongoing.

But much is still unknown about why it works, and it carries risks such as seizures and death.

Dr. Sanacora says it’s unclear whether overdoses are increasing because the federal government doesn’t track ketamine-related deaths the way it does cocaine, heroin and opioid overdoses; sometimes drug testing isn’t even done during autopsies. “There’s a lot we really don’t know,” he says.

Anne Milgram, an official at the US Drug Enforcement Agency, says the agency is targeting doctors who prescribe these drugs even though they are not necessary.

“This is a tragic situation, as we saw at the beginning of the opioid epidemic, where many Americans were getting addicted to controlled substances in doctors’ offices and through medical practitioners, and then it turned into street addiction,” Milgram said, comparing ketamine use to the beginning of the opioid epidemic in the United States.