The ketamine infusion actor Matthew Perry received days before his Oct. 28 death has become a popular mental health treatment across the U.S.
A lower dose of the traditional anesthetic has been used to treat symptoms of depression, typically via IV in clinics. Research has shown its promise, though experts have noted the clinics haven’t been as regulated.
“If there are going to be regulations, it’ll be on the boards for nursing and medicine,” said Ladan Eshkevari, nurse anesthesiologist and CEO of Avesta Ketamine Wellness Center, which has clinics in the Washington, D.C., area. “I’m not sure how that will come about, but right now, with the world we live in, we have to be more conscientious and ethical in our practice than ever before.”
Ketamine infusion clinicians said dosage is a fraction of what patients receive in operating rooms. Patients are awake or semi-conscious during a few hour-long IV sessions overseen by an anesthesiologist, who administers the drug, alongside staff such as a psychiatrist, nurses or social workers who screen patients.
The ketamine infusion Perry, 54, had wouldn’t have lasted that long since the drug’s half-life is only a few hours, according to the autopsy report. However, his death in his Los Angeles home’s pool was ruled an accident because of “acute effects of ketamine” found in his system, with levels akin to those in general anesthesia. Contributing factors were drowning, coronary artery disease and effects of buprenorphine, an opioid use disorder medication. Perry, who publicly talked about substance abuse, had reportedly been sober for 19 months, the autopsy report said.
Research shows mental health benefits, though risks for substance abuse
Ketamine use for mental health poses risks for people with substance use disorder history, Dr. Peter Grinspoon, of Massachusetts General Hospital, said in a Harvard Medical School article. Ketamine has also been known as a street drug.
“It’s not a normal drug to be used by a regular person at all,” said Dr. Fahmi Farah, a cardiologist in Fort Worth, Texas. Ketamine’s traditional use in operating rooms includes constant monitoring, often with a ventilator to help patients breathe, she said.
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Ketamine has shown promise in mental health. Two 2019 studies showed esketamine, a ketamine nasal spray approved by the U.S. Food and Drug Administration to treat depression in certain circumstances, showed it eased treatment-resistant depression over shorter and longer periods.
More recently, the FDA warned about risks of compounded ketamine, including oral products, to treat psychiatric disorders, especially with telemedicine companies prescribing ketamine.
Clinics use fraction of dosages compared to anesthesia, providers say
At Avesta, in Washington, Eshkevari said doctors prescribe esketamine in exact amounts. If a patient is misusing, clinicians cease prescriptions.
“We do the IV protocol, but we do not prescribe at-home for those with a history of substance use disorder,” she said, adding doctors don’t prescribe oral ketamine.
Somatic psychotherapist Mariya Jayed-Payne, who owns Awaken Consulting Services in Minnesota, combines ketamine with psychotherapies. A mental health professional monitors patients during treatment.
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Infusion clinics want people to know what they do
Sam Mandel, co-founder and CEO of Ketamine Clinics Los Angeles, said patients with appointments have emailed concerns after Perry’s death. Linking his death from suspected uncontrolled use hurts those in need of help for mental health issues, he said.
“People are afraid,” said Mandel, who founded the clinic with his father, Dr. Steven Mandel, an anesthesiologist, nearly a decade ago. “There’s no connection between therapeutic, clinic use of ketamine and what happened with Matthew (Perry).”
In Perry’s case, Eshkevari said medical teams must ensure patients use ketamine responsibly. While ketamine is safe and heavily monitored by doctors, she said people can obtain it through online pharmacies, a risk with people trying to dose themselves.
