Ketamine has been making the news a lot lately. The recent medical examiners report on Matthew Perry’s cause of death being related to “acute effects of Ketamine” has brought the substance under scrutiny. Let me start by saying that Perry’s death is tragic and heartbreaking. People have valid concerns about incorporating ketamine and other psychedelics into a therapeutic model. People are rightly cautious that it could cause further addictions, health problems, and even death.
AND I’d like to invite a wholistic, nuanced, wise, and informed approach to this topic.
Using ketamine in a therapeutic setting doesn’t mean doing rails of K at a rave, crossing your fingers, and hoping all your trauma will go away. And it certainly doesn’t mean doing a bunch of Ketamine and then getting into a hot tub with no one else around, especially if you also have buprenorphine in your system.
What happened in the Matthew Perry case is devastating, and I have deep empathy for his struggle with pain and addiction. It was bound to happen—a high profile case where ketamine was involved and went awry. It is my understanding that Perry was doing ketamine infusions as part of a therapeutic treatment plan. I wish I knew more about what was actually part of that treatment plan. Did he have a strong therapeutic relationship to help with integrating what was coming up during his sessions? Was he looking deeply into past traumas?
Regardless of all of this, it seems that the evidence is pointing to him taking a pretty high dose of oral ketamine on his own at home, with no other human around to monitor his safety, with buprenorphine in his system, and then getting into a hot tub. Buprenorphine and the amount of ketamine likely caused both his breathing to slow down to a dangerous level.
The likely cause of death was not from the actual Ketamine, but from drowning.
Given that Matt (I don’t know, a first name basis seems more human-centered) had a pretty extensive knowledge of drugs, how they worked, and what can happen, I do wonder if it was a passive or even an intentional suicide attempt to take such a high dose alone and get into a hot tub. Of course, I hope not to offend anyone by suggesting this, but it is worth being curious about.
I recently asked an email list that is comprised of Ketamine experts, including medical providers, to weigh in on this case. The general consensus was that we will never know if Matthew Perry would have died had he not been in a hot tub. The substances alone may have killed him by slowing his breathing rate down so low that it caused him to go into respiratory arrest and subsequently cardiac arrest. BUT it is also likely that he would NOT have died had he not been in a hot tub and was doing this substance without medical guidance and supervision.
One medical provider on the list serve pointed out that alcohol, tobacco, and firearms cause infinitely more deaths than ketamine.
It is highly unlikely that someone will die from an overdose on Ketamine alone. It is one of the safest substances you can put in your body actually. We have given babies 3 times the amount that one generally takes during Ketamine Assisted Psychotherapy.
We must use ketamine and other psychedelics with intention, humility, and respect. The medicines themselves are not enough to heal trauma, depression, addiction, or other mental health struggles; they are simply a catalyst. These medicines can help the neurological connections in our brains that are so infused and organized around self-protection and trauma to soften. This allows healthy neurological patterns to get stronger.
We often need the therapeutic container to help with this process. Although I honor that life is messy and people going into ketamine infusion clinics with no therapist in the room may be a more affordable option for folks. I have a few clients that are doing that, but then coming to me for integration. I do believe though that having someone that has therapeutic training, that cares about you as a person and that is providing an attuned and empathic nervous system while you are in an altered state has its own therapeutic value, especially when there is an attachment component to the wounding.
There is also the importance of integration.
I have shared my own experience with Ketamine Assisted Psychotherapy before many times and I deeply credit this approach to helping me unhook from an unhealthy relationship with alcohol and heal the deepest parts of myself that I simply couldn’t get to with even the deepest of somatic approaches to trauma.
I am deeply saddened by the death of Matthew Perry. I understand that in many circles, this is more evidence that we should stay away from Ketamine as a therapeutic tool and we should stay with the conventional methods. I would only invite a more nuanced approach to this topic. I would invite an examination of bias and stigma. I would also invite an awareness that a great deal of folks are making progress in their healing journeys that these more conventional methods just aren’t yielding.
Ketamine is not the end-all-be-all. It is not a magic pill or a cure-all. We all must follow our own intuition, boundaries, and what we know is best for our journey. AND we shouldn’t completely take a dogmatic stance because of one high-profile case or because we know someone who has misused this drug and have a certain bias towards it.
May we all find our own paths to healing this year.
A.V.O.S. Counseling 