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Shutterstock<\/span><\/div>\n<\/div>\n<\/figure>\nClimbing into his backyard jacuzzi that overlooked the Santa Monica Mountains, Matthew Perry uttered the seven words that would ultimately lead to his death: \u201cShoot me up with a big one.\u201d<\/p>\n
The big one, court documents would later reveal, was a dose of ketamine, a prescription anaesthetic and a hallucinogen that has become popular for its off-label uses to treat depression and anxiety. It was the actor\u2019s third injection of the day.<\/p>\n
Hours after that fatal dose, the \u201cFriends\u201d actor was found face down in the jacuzzi. Medics pronounced him dead<\/a> at the scene with a coroner finding ketamine was his primary cause of death.<\/p>\n The details about Perry\u2019s last day alive on 28 October 2023 were revealed in court documents following a police probe that ultimately led to five people being charged<\/a> in relation to his death.<\/p>\n The documents offer an in-depth look by the law enforcement agencies into his drug addiction, which he struggled with for decades, and a glimpse into Hollywood\u2019s ketamine drug network. Doctors and experts told the BBC the growth in ketamine\u2019s popularity in recent years has caused the market to explode, with the expansion of ketamine clinics and online services offering easy prescription access to the drug, as well as a burgeoning illicit drug market.<\/p>\n \u201cIt\u2019s super easy [to get], – be it underground or prescription,\u201d Dr David Mahjoubi, who serves as president of the American Board of Ketamine Physicians, told the BBC. \u201cI have celebrities that are getting a prescription from me. It\u2019s super easy, not hard at all.\u201d<\/p>\n<\/div>\n Federal authorities said their investigation into Perry\u2019s death uncovered a \u201cbroad underground criminal network” of drug suppliers who distributed large quantities of ketamine across Los Angeles.<\/p>\n Federal court documents detail Perry\u2019s last months alive and the transition from his treatments at a ketamine clinic for depression and anxiety, where a physician administered the drug and monitored for side effects, to an addiction that led him to \u201cunscrupulous doctors\u201d and a network of street dealers.<\/p>\n Perry had been open about his addiction problems<\/a>, which stem back decades – even to his time playing Chandler Bing on \u201cFriends\u201d. If a drug entered his life, he seemed to become addicted.<\/p>\n But in his memoir Friends, Lovers, and the Big Terrible Thing, he said he\u2019d finally got sober, and one woman told investigators at the coroner\u2019s office that she believed he\u2019d been sober for 19 months.<\/p>\n Somewhere in that time, he started receiving ketamine infusion therapy<\/a>. Experts say Perry\u2019s history of addiction helped lead him to quickly become hooked on the drug.<\/p>\n The federal investigation found<\/a> that over a nearly two-month span before his death, Perry purchased dozens of vials of ketamine for thousands of dollars.<\/p>\n Over the three days before his death, his assistant injected him at least six times a day with ketamine shots.<\/p>\n<\/div>\n Five people were arrested in the probe – three of whom already pleaded guilty in the conspiracy. In total, the group faces 23 counts in Perry’s death.<\/p>\n Numerous doctors and experts who spoke to the BBC for this story spoke about the toxic relationship between celebrity and medicine.<\/p>\n “The VIP treatment is usually not the best treatment,” Dr Gerard Sanacora, director of Yale University\u2019s Depression Research Program, told the BBC.<\/p>\n “Doctors are humans, too, and despite taking the Hippocratic oath, not everyone abides by it,” he added, acknowledging doctors can “lose perspective when you have a VIP client” and there’s promises of invites to big parties or donations to research programs or charities.<\/p>\n Dr Mahjoubi, who operates two ketamine clinics in California – including one in Los Angeles \u2013 told the BBC that when celebrities are your patients, normal boundaries can be hard to maintain.<\/p>\n He said he was treating one unnamed celebrity who he offered his cell phone number to in case of emergencies.<\/p>\n The patient was \u201cconstantly trying to asking me favours – \u2018hey, refill my prescription\u2019- and it\u2019s like Sunday evening.\u201d<\/p>\n \u201cI told him, \u2018Look please email me anything medically related\u2019 and blocked him,\u201d Dr Mahjoubi said.<\/p>\n He also said he\u2019s seen how ketamine has become a \u201cgo-to\u201d party drug for celebrities, who think it is safer than something like cocaine, which can be laced with deadly drugs like fentanyl.<\/p>\n Another Los Angeles area doctor, who operates several pain management centres – another condition ketamine is marketed to – called the spread of ketamine treatments the new \u201cwild west\u201d.<\/p>\n He spoke to the BBC on the condition of anonymity to candidly discuss ketamine’s popularity, detailing the nuanced relationships he\u2019s witnessed between doctors and some celebrities.<\/p>\n<\/div>\n Everyone wants to be a \u201cdoctor to the stars here\u201d, the doctor explained. Some will go so far as offering free treatments or closing down their clinic or office for private access, all with the hope the celebrity patient will post about their treatment on social media.<\/p>\n \u201cThere are celebrities who are passed around from doctor-to-doctor and they are fought over,\u201d the doctor added, calling it both \u201ca weird relationship\u201d and troubling business model.<\/p>\n A lot of these stars are \u201cused to being told \u2018yes\u2019,\u201d he said.<\/p>\n \u201cIf you don\u2019t, they\u2019ll just go to someone else who will give them what they want.\u201d<\/p>\n Being surrounded by \u201cyes men\u201d can have life-changing ramifications, said Garrett Braukman, the executive director of the Alta Centers, a rehabilitation and detox treatment centre in Hollywood. About 20 to 30% of patients work in the film industry.<\/p>\n He said he\u2019s seen an uptick in ketamine addiction, but its not outpacing commonly abused substances like alcohol, cocaine and opioids.<\/p>\n “People often get into the arts because of things they’ve experienced – a lot of time that’s trauma,” Mr Braukman said. When you add in Los Angeles\u2019 fairly \u201cnormalized\u201d drug culture and celebrity access, \u201cit’s the perfect recipe for addiction,” he said.<\/p>\n<\/div>\n A simple Google search for \u201cketamine prescription\u201d reveals a handful of advertisements for online companies touting the benefits of \u201cpsychedelic therapy\u201d to treat illnesses from depression and anxiety to Lyme disease and chronic pain, some offering a subscription for just $100 a month to get the drug. <\/p>\n One problem: The drug isn\u2019t approved to treat those conditions.<\/p>\n The US Food and Drug Administration – the regulatory agency responsible for approving drugs and ensuring they\u2019re safe, work and labelled properly – has only approved ketamine for general anaesthesia used under the care of a physician.<\/p>\n In 2019, the FDA approved a nasal-spray drug that is made from ketamine and okayed its use to treat depression, so long as the drug is coupled with additional therapy and administered under the direct supervision of a doctor. The doctor must also monitor the patient for two hours after the dose has been taken for potential side effects, which include hallucination, feeling disconnected from reality and increased blood pressure.<\/p>\n But these online clinics have exploited a grey area in the regulations to market off-label ketamine prescriptions directly to consumers, experts say.<\/p>\n While FDA advertising regulations restrict pharmaceutical companies that \u201cmanufacture, distribute, or pack\u201d, they do not restrict new start-ups, like online \u201cwellness\u201d clinics.<\/p>\n \u201cIt\u2019s a very tricky thing – it\u2019s a loophole almost,\u201d Dr Sanacora told the BBC.<\/p>\n Two weeks before Perry\u2019s death, the FDA warned consumers about ketamine’s off-label use<\/a>, noting \u201cthe lack of monitoring for adverse events, such as sedation and dissociation, by an onsite health care provider may put patients at risk\u201d.<\/p>\n Doctors and experts say the market seemed to boom during the pandemic, when online telehealth services, clinics and at-home care proliferated.<\/p>\n The pain management doctor, who had spoken to the BBC on condition of anonymity, said some of these companies are structured in ways that \u201cdon\u2019t want people to get better\u201d but rather, to keep them on prescription subscriptions that keep money pouring in.<\/p>\n \u201cIt\u2019s gotten out of hand,\u201d he said.<\/p>\n Dr Sanacora, who has studied and researched how ketamine can be used to treat depression, said there is a lot of evidence of the drug’s efficacy. <\/a>Drug trials are currently underway<\/a> testing the merits of ketamine treatment for treatment-resistant depression. <\/p>\n But much is still not known about why it works, and it does come with risks, such as seizures and death.<\/p>\n Dr Sanacora said it’s unclear whether overdoses have increased, because the federal government does not track ketamine-related deaths, which it does for cocaine, heroin and opioid overdoes. Sometimes the drug is not even tested for during autopsies.<\/p>\n “There’s a lot we really don’t know,” he said.<\/p>\n The DEA\u2019s chief Anne Milgram said the agency is targeting doctors who are over prescribing these drugs or prescribing it when it is not necessary.<\/p>\n Speaking with CBS News, the BBC\u2019s US news partner, she compared ketamine and its use in the Perry case with the start of the opioid epidemic in the US.<\/p>\n \u201cThis, unfortunately, is a tragic arc that we have seen thinking back to the beginning of the opioid epidemic, where many Americans became addicted to controlled substances in doctors’ offices and through medical practitioners that then turned into street addiction as well.\u201d<\/p>\n<\/div>\n<\/div>\nAn underground network<\/h2>\n<\/p>\n
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United States Attorney\u2019s Office for the Central District of California<\/span><\/div>\n<\/div>\n\n
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Jasveen Sangha’s social media<\/span><\/div>\n<\/div>\n‘Yes men’<\/h2>\n<\/p>\n
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Getty Images<\/span><\/div>\n<\/div>\nThe start of a new prescription epidemic?<\/h2>\n<\/p>\n