We Still Need to Talk About Matthew Perry
The aftermath of Matthew Perry’s untimely and tragic passing has been an interesting one. Sensationalistic headline after headline targeting ketamine as the "bullet in the chamber" that led to Matthew Perry's death has highlighted the lack of understanding in the complexities and nuances of psychedelic medicine. With ketamine in the crosshairs, there has been an inquisition-level of scrutiny and backlash into this medicine which has literally been the only medicine to help people suffering from mental illness. People relegated to chronic set-and-forget antidepressants with limited or no options.
To frame this correctly, we need to look honestly at the facts of this case. He was home alone and unsupervised. He ingested an anesthetic level dose of ketamine, which is not indicated when treating any mental health indications – FDA approved or not. He had buprenorphine in his system – an opiate known to cause respiratory depression at high levels. Ketamine does not normally compromise the respiratory system, but at high enough levels, can cause laryngospasm (muscular spasm causing closure of the upper airway) and disorientation (impairing movement and decision-making). Entering a “K-hole” is a known side effect of taking too much ketamine in recreational settings, leading to a complete dissociation of body from mind. Perry took these medicines in a body of water. He found himself face down in his hot tub either due to respiratory arrest or disorientation and had no capacity to help himself.
“This is an unfortunate example of how not to use ketamine”
This was not a case of death due to the "acute effects of ketamine," but rather the consequences of taking a medicine at home, unsupervised, without a proper healing container or framework, and with competing medications in his system. This is an unfortunate example of how not to use ketamine, but make no mistake, ketamine did not kill Matthew Perry, the circumstances around his ketamine use did.
Matthew Perry was a man in pain. He openly talked and wrote about his struggles in his memoir and was likely searching for a way to live authentically in his skin. He made a poor choice and suffered the ultimate price. There are so many necessary and timely conversations that need to happen, but instead every manner of "expert" is weighing in, scapegoating ketamine, and pontificating about a topic they frankly don't understand.
The boom of ketamine telehealth providers has called into question the rapid expansion of at-home ketamine service. Without the proper infrastructure, training, and support to properly care for clients or patients, unsupervised settings increase more risks for a medicine that, to be blunt, has an incredible generous safety profile. Instead, psychedelic medicines are being treated like the next new pill, to prescribe and profit, without any clear understanding of their true value to address the root causes of pain and suffering that lead to all manners of mental illness. When we look at the causes of mental illness, we see a common path inclusive of psychological and emotional challenges, and even physical ailments as a result of repressed, untreated trauma. Companies opting to prioritize profits over people are attempting to cash in on the psychedelic renaissance, leaving those susceptible and vulnerable exposed and exploited.
As the field of psychedelic medicine grows, we will have new options and new medicine to work with. On December 12, 2023, the Multidisciplinary Association for Psychedelic Studies (MAPS) filed a New Drug application (NDA) for MDMA-Assisted Therapy for PTSD, which could mean this medicine is available for prescribing by 2024. We may see the same for psilocybin in the near future if the clinical trials continue to show promise and statistical significance. We are on the precipice of a major paradigm shift, and there will continue to be situations like Perry’s where a paucity of information, lapse in judgement, ignorance or addictive tendencies get the better of someone. This does not mean that the medicine or the individual is to blame. This means there are more opportunities for educational and healing platforms, training programs, harm reduction services, multidisciplinary conversations, and resources to be developed and disseminated.
For those of us who approach this work with integrity, utilize and/or create healing frameworks and education to guide clients or patients, work alongside educated and skilled colleagues, train in both medicine and mysticism, painstakingly create safe healing containers for this work to be held, and continually work through their own shadows to show up whole and healed, these headlines and tragedies are beyond frustrating. They highlight the enormous knowledge gap between perceiving psychedelic compounds as pharmaceuticals versus entheogenic medicines able to catalyze deep and meaningful change. Psychedelics are a tool, and as such, are only as effective as the skillfulness of the hands, and heart, that wield them. In the wrong hands, we have seen any number of tragedies occur. In the right hands, we can see and even begin to expect magic.
