Matthew Perrys ketamine OD prompts questions about its use for mental illness

Actor Matthew Perry’s death in October from ketamine has sparked new concerns and investigations focused on the drug’s unapproved use.

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

Although it is not FDA approved for psychiatric disorders, doctors can legally prescribe it as an off-label treatment.

Meanwhile, the pandemic waiver allows doctors to prescribe ketamine via telemedicine without an in-person exam. Some patients receive ketamine in clinics or at home in the presence of a therapist, and some use it unsupervised at home.

Perry battled alcohol and drug addiction throughout his life. He’s been open about his struggles, detailing his dozens of stays in treatment and the devastating impact addiction has had on his health.

Perry, 54, legally gets ketamine infusions 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 report of autopsy.

While the Los Angeles medical examiner determined that ketamine was the main cause of her accidental drowning in a hot tub, other contributors included heart disease and buprenorphine, which is commonly used to treat opioid addiction and sometimes as a painkiller. The ketamine would speed up his heart rate while slowing his breathing, according to the medical examiner.

In October weeks before Perrys death, the FDA published a warning about ketamine, citing risks including abuse, increased blood pressure and bladder problems, and risks of using it at home without health care provider companion.

The US Drug Enforcement Administration is already developing new rules that will limit the use of telemedicine to prescribe drugs including ketamine.

Deaths like Perry’s are considered rare. However, it has prompted new discussion and concern. The American Society of Ketamine Physicians, Psychotherapists and Practitioners called the star’s death a wake-up call for ketamine practitioners and the wider medical community to put clear and unified guardrails in place of real-world data and medicine, the Washington Post reported. The non-profit group said it will develop guidelines for ketamine use at home.

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

Adam Kaplin, chief scientific officer for Mira Pharmaceuticals, cited by The Washington Post, believes that ketamine has great potential to help people with mental illnesses, saying Perrys death is a potential dangerous practice to give patients access to it at home.

At the same time, various start-ups are working to increase access to ketamine for people with difficult-to-treat depression and other mental illnesses.

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 unaffordable for many patients if they are not allowed to use it at home, according to the Post.

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