The Drug Enforcement Administration says it will be heavily scrutinizing doctors who prescribe ketamine for mental health purposes in the wake of Matthew Perry’s death—part of what experts say is a public relations strategy to justify the agency’s ongoing drug war.
The Friends actor, 54, drowned in a hot tub at his Los Angeles home in October, after consuming a large dose of ketamine, an anesthetic with dissociative effects. According to the medical examiner’s report, his accidental death was caused by the “the acute effects of ketamine,” with contributing factors listed as drowning, coronary artery disease and buprenorphine. But at the time, toxicologists said it’s unlikely Perry—who had enough ketamine in his system to undergo surgery—would have died if he had not been in a body of water.
On August 19, the DEA announced that five people had been charged in connection with his death, including two doctors, an alleged North Hollywood drug seller described as the “ketamine queen,” and Perry’s assistant, who allegedly injected him with ketamine, including on the day he died.
Perry had been undergoing ketamine infusion treatments in a clinical setting to treat his depression. But DEA Administrator Anne Milgram said in a press conference that “when clinic doctors refused to increase his dosage, he turned to unscrupulous doctors who saw Perry as a way to make quick money.”
The DEA alleged that Dr. Salvador Plasencia contacted Dr. Mark Chavez, who previously ran a ketamine clinic, to illegally obtain the drug for Perry, texting, “I wonder how much this moron will pay.”
Chavez, who pleaded guilty to conspiracy to distribute ketamine causing death, allegedly procured the ketamine by filling a fraudulent prescription and through “ketamine queen” Jasveen Sangha. Sangha allegedly charged Perry over $50,000 for about 50 vials.
Milgram told CBS that Perry’s case was reminiscent of the early days of the opioid-involved overdose crisis, “where many Americans became addicted to controlled substances in doctors offices and through medical practitioners that then turned into street addiction.”
She said the doctors didn’t evaluate Perry correctly and left behind vials of ketamine for his assistant to inject him with unsupervised.
“We, every single day, are targeting and investigating doctors, nurse practitioners, others who are violating this duty of trust to their patients by over-prescribing medicine or prescribing medicine that isn’t necessary,” she said.
Pain patients, in particular, and advocates have pointed to how earlier prescribing crackdowns have caused harms including exacerbating the overdose crisis.
“They use the popularity of the person and the tragedy to center themselves in the conversation, to peddle disinformation, kind of fueling drug panics, and essentially pat themselves on the back.”
The circumstances surrounding Perry’s death may point to a need for better regulation of the ketamine industry, which has exploded in the last few years, with hundreds of clinics opening across the country. The pandemic also made it much easier to obtain prescriptions for intranasal and oral ketamine, which can be taken at home without supervision.
However, Milgram’s framing of Perry’s death is also a public relations play for the DEA, said Leo Beletsky, a Northeastern University professor of law and health sciences.
“There’s a long line of cases just like this where a high-profile person, oftentimes a celebrity … dies of drug-related problems, overdose or other related issues and law enforcement use these deaths as an opportunity for a PR campaign,” he told Filter.
Similarly to Perry, there were large-scale investigations following the deaths of actor Michael K. Williams and rapper Mac Miller.
“They use the popularity of the person and the tragedy to center themselves in the conversation, to peddle disinformation, kind of fueling drug panics, and essentially pat themselves on the back,” Beletsky said.
Perry’s assistant, Kenneth Iwamasa, has pleaded guilty to conspiracy to distribute ketamine causing death and is facing up to 15 years in prison. In the case of opioid overdoses particularly, people who sell or even share drugs with someone who then dies are increasingly being charged with murder.
“We can have a conversation about whether or not it makes sense to charge, like, bona fide drug dealers with dealing drugs to folks,” Beletsky said. But when Iwamasa was employed by Perry and appeared to be following his demands to procure ketamine, “holding them accountable for this and giving them a long prison sentence serves no one except for law enforcement.”
“Mr. Perry (and his deep pockets) are no longer around to protect the assistant. Without that patronage, the legal system has come for him.”
Observers including celebrity gossip columnist Perez Hilton have asked if Iwamasa should be charged with involuntary manslaughter because he had found Perry unconscious multiple times in the weeks leading up to his death, according to a plea agreement obtained by Page Six. On the day he died, Perry instructed Iwamasa to inject him with ketamine three times. “Shoot me up with a big one,” he said before his final dose.
In an August 21 New York Times essay, Harvey Weinstein’s former assistant Rowena Chiu described an inherent power imbalance between a celebrity and their assistant, where the former is “surrounded by a stream of sycophants who tell them they are above the law.”
“Mr. Perry (and his deep pockets) are no longer around to protect the assistant. Without that patronage, the legal system has come for him,” Chiu wrote.
Milgram’s description of ketamine as a drug that “has a high potential obviously for addiction,” is also a mischaracterization, according to doctors who work with the substance.
Ketamine has been used as an anesthetic since the 1970s, but it is not approved by the Food and Drug Administration for mental health conditions, despite strong evidence that it is an effective depression treatment. It is prescribed off-label for mental health issues.
“Opiates have a much stronger addictive potential because it has a very strong withdrawal effect … where people feel very uncomfortable if they don’t continue to take the medication,” Dr. Sandhya Prashad, president of the American Society of Ketamine Physicians, Psychotherapists and Practitioners, told Filter.
Ketamine-involved deaths are rare. A 2021 study published in the Journal of Psychopharmacology in 2021 found that in England, where unregulated use of the drug is much more popular, there are around 30 deaths a year with ketamine present. Other drugs are also present in most cases, and it shouldn’t be assumed that ketamine caused the deaths.
Still, Prashad said you can become psychologically dependent on ketamine, just as you can with many substances and non-drug activities. At that point, she said, it might become much less effective as a medical treatment, partly because a person’s tolerance would go up if they use a lot. Prashad said she’s not convinced Perry would have been a good candidate for ketamine infusion, given his history with substance use disorders.
“I’m very worried, absolutely. I think they’re going to crack down.”
Ketamine providers have been dealing with supply chain issues, Prashad noted, as some wholesalers are being increasingly restrictive about selling the drug to mental health clinics. The scrutiny over Perry’s death will make it even harder to obtain, she said, which she doesn’t think is a good thing.
Neither does Kimberly Juroviesky, 53, a military veteran who has been using ketamine to treat complex regional pain syndrome for 10 years. While she said ketamine infusions have provided her with tremendous relief from her pain, she has “never, ever craved it, never wanted to use it illicitly.”
“I’m very worried, absolutely. I think they’re going to crack down,” she told Filter.
Juroviesky said she wants to see the FDA regulate ketamine as a mental health treatment and come up with proper protocols for usage.
Prashad said having insurance companies cover ketamine therapy could help increase patient protection, because there’s a process to follow before someone would get approved, taking into account their medical history. She also suggested a registry of ketamine providers could add guard rails.
“Making it harder for people to access drugs drives people to unsafe use behaviors, like using alone, and also creates a market for unethical people to take advantage.”
Dr. Ryan Marino, medical director of toxicology and addiction medicine at University Hospitals in Cleveland, said the doctors’ alleged actions in the Perry case were “more than just unethical.”
“But Matthew Perry drowned while intoxicated on ketamine the same way people routinely drown while intoxicated on alcohol,” he told Filter. “Making it harder for people to access drugs drives people to unsafe use behaviors, like using alone, and also creates a market for unethical people to take advantage, like this case.”
“It feels like the DEA are simply taking advantage of a tragedy to seek increased relevance, powers, and funding, when they have not made any improvements in the opioid problem by following this same exact playbook for many years now,” he continued.
Celebrity overdose cases often elicit emotional responses from the public, with calls for justice in part because people have an attachment to the person who died. Beletsky said that’s understandable, but that law enforcement tend to elevate those narratives. On the other hand, when people don’t want their friends or family members charged after an overdose, law enforcement “ignore those voices, and they choose to lift up the voices of those who call for more criminal justice intervention.”
During the July 2023 sentencing of Carlos Macci, an illiterate elderly man who was part of the crew that sold The Wire star Williams opioids before he died, Williams’ nephew Dominic Dupont called for empathy alongside accountability: “Michael K. Williams was a person who believed in love, who believed in an opportunity for people to get themselves together.”
Photograph of Perry in 2013 by Policy Exchange via Flickr/Creative Commons 2.0