A federal court has indicted and charged five individuals for contributing to the death of actor Matthew Perry by providing him with the anesthetic ketamine.
On October 28, 2023, Perry was found floating face-down in his hot tub. An autopsy later revealed his death had been caused by “acute effects of ketamine.” Perry, a star of the television show Friends, had long struggled with addiction.
Charged in the 18-count indictment are Perry’s personal assistant, Kenneth Iwamasa; two doctors, Salvador Plasencia and Mark Chavez; and two other individuals, Erik Fleming and Jasveen Sangha. Sangha was known as the “Ketamine Queen” who is accused of running a North Hollywood “stash house.”
Multiple Players Charged
Documents filed by prosecutors claim Perry’s assistant and an acquaintance worked with the two doctors and the drug dealer to provide tens of thousands of dollars worth of ketamine to fuel Perry’s addiction. Fleming coordinated the sale with Sangha, prosecutors say.
Iwamasa provided at least 27 ketamine injections to Perry in the five days leading up to his death, according to the prosecution. Chavez admitted selling ketamine to Plasencia for redistribution to Perry by falsifying information to a distributor and then using a prescription written in the name of a former patient.
When Plasencia texted another doctor about how much to charge Perry for the ketamine, he wrote, “I wonder how much this moron will pay,” and “Let’s find out,” prosecutors say. The trial date for Chavez and Plasencia is set for March 4, 2025.
Binge-Use Temptation
Ketamine is a dissociative anesthetic that can produce hallucinogenic effects. Ketamine is also used as a pain reliever and for the relief of treatment-resistant depression.
Some people use ketamine as a recreational drug for its ability to induce hallucinations. The effects of ketamine are short-lived, and users may rapidly develop tolerance to the drug, leading some to binge-use it.
Celebrity Power, Vulnerability
Ketamine is widely accepted as safe and effective for use as an anesthetic in a clinical setting. Off-label uses of the drug that may lead to abuse have led to rising concerns.
A recent New York Times article questioned the drug’s safety for off-label use in the wake of Perry’s death. Although ketamine ordinarily carries no more risk than other anesthetics, pain relievers, and antidepressants.
Celebrities can use their fame and wealth to circumvent effective safeguards against over-prescription and abuse, says Devon Herrick, a health economist.
“Physicians have significant leeway to prescribe FDA-approved medications off-label,” said Herrick. “Some off-label therapies later become mainstream, while others fall out of favor. What makes Matthew Perry’s situation unique was his celebrity status. Similar to the experience of Michael Jackson, Perry was able to enlist the help of physicians willing to provide him with a risky drug therapy not appropriately monitored.
“It’s unlikely a noncelebrity patient would be able to find a doctor willing to administer an anesthetic in their home,” said Herrick. “The lure of both money and bragging rights to say they’re a celebrity doctor likely culminated in Perry’s demise.”
Off-Label Benefits
Ketamine was developed as an anesthetic agent and was found to help treat some mental health conditions through off-label use, which is a common procedure, says Jeffrey Singer, a senior fellow at the Cato Institute who defends off-label use of the drug.
“Roughly 20 percent of all drugs prescribed in the U.S. are for off-label uses,” said Singer. “The [Food and Drug Administration, FDA] has always deferred to clinicians and clinical researchers on how to use drugs off-label. Once the FDA approves a drug for a particular indication, it permits clinicians to use it for any other indication where clinicians and clinical researchers believe the drug can be helpful.”
This real-world experience brings important knowledge, says Singer.
“As clinical research and clinical experience continue, such off-label drug use can lead to subsequent therapeutic advances,” said Singer. “However, clinical researchers often discover over time that specific off-label uses do not work. Over time, we should learn a lot more about what conditions ketamine works best for and what are the optimal ways to use it for those conditions.”
The system is working, says Singer.
“There is no reason why the FDA should add to the already cumbersome regulatory regime by requiring further approvals for off-label uses,” said Singer. “The FDA should leave the off-label uses of drugs to clinical researchers, clinicians, and the civil tort system.”
Black Market Problem
Adding new legal barriers to ketamine prescription would probably drive those wishing to abuse the drug into the black market, where its use would be wholly unmonitored and more dangerous drugs are also readily available, says Singer.
“People are already getting ketamine in the black market, along with other psychedelics such as MDMA, psilocybin, DMT, and magic mushrooms,” said Singer. “If the FDA further restricted online sales [of ketamine], it would only intensify profits in the black market and drive people to the black market, where the purity and strength of these drugs are less certain.
“We already have seen reports of black market MDMA—“ecstasy” or “Molly”—being laced with fentanyl,” said Singer. “Further restricting online sales of ketamine—or limiting its off-label use by licensed clinicians—will only make it more dangerous for people who continue to use ketamine. But it will not prevent them from using it.”
Kevin Stone (kevin.s.stone@gmail.com) writes from Arlington, Texas.