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Ketamine practitioners are developing new guidelines surrounding using the drug at home in the wake of actor Matthew Perry’s death. 

The Friends’ actor died in a hot tub at his home on October 28 due to the “acute effects of ketamine,” which caused him to pass out and drown, according to a medical examiner’s report released last week. 

While the report said ketamine was the cause of death, and that drowning was a contributing factor, it did not say the ketamine caused a heart attack or respiratory depression. Two toxicologists previously told VICE News it’s likely Perry would have survived  had he not been in a body of water. 

The amount of ketamine Perry had in his system when he died is consistent with the amount used for general anesthesia, the report found. 

Perry was doing ketamine-infusion therapy, administered through an IV in clinics, to help with depression and anxiety. However, the report said the ketamine from his last session couldn’t have been in his system because it took place over a week before his death. 

His death is placing new scrutiny on ketamine-assisted therapy, particularly when the drug is given to people to use at home and not under supervision. 

“These kinds of stories highlight that there should be some guardrails around ketamine. And in my opinion, one of the most clear, obvious guidelines is it should be administered in the office,” said Dr. Brent Turnipseed, co-founder of Roots Behavioral Health, an Austin-based mental health clinic that offers ketamine infusion. 

The American Society of Ketamine Physicians, Psychotherapists, and Practitioners released a statement saying it plans on publishing guidelines for at-home ketamine use in light of Perry’s death. 

The group, comprised of over 500 ketamine providers, said it believes dissociative doses of ketamine (where people feel detached from themselves and their bodies), should only be administered under supervision. 

“However, we acknowledge that there are some situations in which It may be appropriate for a clinician to prescribe at-home use in between face-to-face appointments; and therefore, a unified set of guidelines must be collectively considered and put in place by ketamine practitioners across the U.S.,” the statement said. 

The organization said at-home ketamine should only be available to people with “specific” patient profiles and in the context of “a close relationship with a physician and in-office follow-up.”

“This is a wakeup call for ketamine practitioners and the wider medical community to put clear and unified guardrails in place guided by real-word data and medicine (as opposed to startup profits and flashy business models) in order to protect the people who need this treatment most.” 

Ketamine is used frequently as a surgical anesthetic but the Food and Drug Administration has not approved it as a treatment for mental health conditions; when prescribed in the latter capacity, it is considered “off-label.” 

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Nonetheless, in the last few years, as psychedelics have become more mainstream, hundreds of ketamine clinics have popped up across the U.S.. 

During the pandemic, relaxed regulations allowed doctors to prescribe medications remotely, which led to a boom in companies offering oral or intranasal ketamine following telehealth consultations that typically last around half an hour. 

In October, the FDA issued a warning about the use of at-home ketamine products, noting potential safety concerns “including abuse and misuse, psychiatric events, increases in blood pressure, respiratory depression, and lower urinary tract and bladder symptoms. Home use of compounded ketamine products presents additional risk because onsite monitoring by a health care provider is not available.” 

Turnipseed said when his clinic started offering ketamine in 2018, he allowed some patients to take it at home. But he said more and more patients began telling him they felt the “urge to compulsively take it,” prompting his clinic to shut down that program. (Ketamine carries a lower addiction risk than other drugs, like opioids, and does not cause physical withdrawal symptoms, but it is still possible to use it problematically.) 

Turnipseed said he understands the argument for take-home ketamine—it’s much cheaper than the hundreds of dollars a person would pay for a dosing session at a clinic, in addition to the cost of therapy sessions. But he still thinks it’s “too risky” even if you advise people to take the drugs under supervision and not to use them while in water. 

“When someone's got these drugs, their medicine at home, you can't police what people are doing at home at all.” 

Other ketamine proponents are worried that Perry’s death will further stigmatize a relatively safe drug. 

“If it wasn't for ketamine, I wouldn't be here today,” said Kimberly Juroviesky, a veteran who uses ketamine to manage her chronic pain and depression. 

“People take pain medicine at home prescribed every single day of the week, and the majority of those people do not overdose on it,” she said. 

Fatal ketamine overdoses are rare. 

A 2021 study published in the Journal of Psychopharmacology found in England, there are around 30 deaths linked to ketamine a year, a number that’s risen from around 5 per year between 1997-2005. Most deaths involved other drugs. 

Juroviesky, president of the Ketamine Taskforce, a volunteer organization that helps veterans access ketamine, said because ketamine as a treatment for mental disorders is off-label, it’s much harder to regulate. 

“There needs to be stricter guidelines for dosing protocols,” she said, adding that she believes companies that offer at-home doses should do live check-ins to make sure patients have a sitter with them when they’re taking the drugs. 

Turnipseed said the lack of oversight in ketamine administration could pose long-term problems for the nascent industry.  

“It could threaten the whole industry and patients' ability to access it at all.” 

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