|
Medical ketamine has been safely used as an anesthetic for decades and is an increasingly mainstream treatment for depression and other psychiatric disorders. But when actor Matthew Perry died from an overdose in October 2023, his death thrust ketamine into the headlines, raising questions and concerns about the drug’s safety and potential for abuse.
For help with these questions and concerns, we reached out to Warren Gumpel, who directs our Ketamine Services Program and is a leading expert in the field. In the last decade, Gumpel has helped various providers nationwide implement best practices in ketamine treatment and improve care outcomes. He is also the co-founder of the non-profit organization, The Ketamine Fund, which aims to reduce rates of suicide by making ketamine accessible to veterans.
We asked Gumpel to comment on medical ketamine in the aftermath of Perry’s death. Could he share some takeaways from Perry’s story for those who may be considering ketamine treatment for themselves or a loved one but have concerns about the drug’s capacity for abuse or overdose? We invite you to catch his insights in the sections that follow.
Addiction and Overdose Dangers of Medical Ketamine?
Perry was reportedly receiving medically supervised ketamine infusions for depression and anxiety, but it was not the medical ketamine that took his life. At some point during his treatment, the actor began obtaining ketamine on the side, with the help of multiple people who have since been charged for illegally supplying him with ketamine. They include a doctor, a drug dealer known as “the ketamine queen,” and a live-in assistant, who was injecting Perry 6-8 times a day during the late stages of his addiction.
Can You Get Addicted to Ketamine from IV Treatment?
For some, Perry’s story raises questions about the addictive dangers of medical ketamine, which as a Schedule III drug is supposed to be less addictive than cocaine (Schedule II) or heroin (Schedule I) drugs. Is it possible to get addicted to ketamine after beginning IV treatment for depression or another psychiatric disorder? we asked Gumpel.
“The consensus among doctors that I know within the ketamine community is that people don’t get addicted to ketamine from ketamine infusions,” Gumpel said. He noted there is some potential for abuse — just as there is with many medications. The DEA states that it is possible to develop a mild or moderate dependence on the drug, for example, and for this reason, not every person is a good candidate for IV ketamine treatment. Certain health conditions or risk factors may preclude it.
Matthew Perry’s situation was also unique. As a celebrity with a very public history of drug and alcohol addiction, Perry was far more susceptible than the average person to exploitation by those who sought to profit off his addictive tendencies and had the means to do so, according to Gumpel:
He was doing ketamine treatments and then found a doctor who would come and do it for him at his home … He was being aided in his abuse of ketamine by a doctor who was making a lot of money to supply it to him, and who was incentivized to get him to take it more and more.
Just how much was that monetary incentive? At the height of his addiction, Perry was spending $55,000 a month on ketamine, according to news sources, when in actuality “ketamine is one of the cheapest medications — “the real cost is about $10 for a whole vial of 1000 mg,” Gumpel said. He continued:
I don’t want to speculate about whether Perry was demanding ketamine or doctors walked him down that road, but there were many people whose incentive was to keep Perry doing ketamine and a cottage industry of people who were taking advantage of him.
What Are the Overdose Risks of Ketamine?
One tragic lesson from Perry’s story is that you can die from an overdose if you are using ketamine recreationally to self-medicate. High doses of ketamine, when injected, also increase the likelihood of overdose and death. (And, of course, many other therapeutic prescription drugs, when misused, do the same.) The blood level of ketamine in Perry when he died was 3,540 ml. That is within the range used for general anesthesia.
It is also exponentially more than the amount used in an IV treatment. The prescribing protocol for IV ketamine, in contrast, is a gradual titration over more than 45 minutes of .5 mg per kilogram of weight—the smallest dose at which the drug’s therapeutic effects are known to occur, Gumpel said. This conservative dosing regimen helps to explain why there has not been one recorded overdose or death from medical ketamine for depression.
Medical Ketamine vs. “Special K”
“Special K,” as it is called, is the street name for ketamine. Pharmacologically, the two are the same substance, but the risks and dangers of illicit ketamine far exceed those of medical-grade ketamine. Gumpel summed them up this way:
Buying street drugs in this country is absolutely playing Russian roulette with your life, because the entire drug supply is contaminated with fentanyl. Special K, ecstasy pills, etc. are contaminated … When you’re buying drugs on the street, you have no idea of the provenance, the purity, or if it’s even ketamine.
Ketamine’s Mode of Action – How Context Is Everything
While ketamine and Special K’s mode of action is the same — they both produce sedative, anesthetic, and dissociative effects — their context is very different: “We’re using medical-grade ketamine that’s prescribed by a psychiatrist in a medical setting and intravenously administered with a nurse sitting beside you,” Gumpel said, describing how IV ketamine works at FHE Health and in other trusted medical settings. He continued:
We’re aiming at a sub-anesthetic-dissociative dose. Much of the difference hinges on whether you are planning to be in a medically supervised environment where you can explore that dissociative space safely or whether you’re taking it in a night club or in a jacuzzi.
Why IV Ketamine Is Not (Yet) FDA-Approved
Despite a large body of research testifying to its safety and life-saving efficacy as an off-label treatment for depression and other psychiatric disorders, IV ketamine has yet to be FDA-approved for this purpose. What’s the hang-up, given the need for a fast-acting solution to suicidal ideation and other severe symptoms of anxiety, depression, and PTSD? Here is how Gumpel answered that:
Many psychiatric medications are used off-label, and over 50 percent of drugs are used off-label. Ketamine is off patent, so to get it in phase 3 for approval by the FDA costs hundreds of millions of dollars, and there’s no stakeholder who can make money from doing that.
This reality helps to explain why Janssen Pharmaceuticals isolated the mirror molecule “esketamine” to create an intranasal spray, Gumpel said. The real reason Janssen patented the molecule and put a name on it (“Spravado”) was to make money.
Even without the same money-making incentive to support its approval by the FDA, the r-ketamine (racemic) molecule that’s used in intravenous treatment “works better” than esketamine in treating depression, Gumpel said, citing a 2022 study in the Journal of Affective Disorders. He added that he has found the same to be true from his own more anecdotal experience.
In other words, IV ketamine is not just more cost-effective than its intranasal counterpart, according to a retrospective study — it is also a more efficacious treatment for depression.
Final Takeaways for Anyone Considering IV Ketamine
What takeaways from this tragedy are most important for anyone considering ketamine treatment? we asked Gumpel. He emphasized that ketamine treatment is not for everyone and “needs to be analyzed on a case-by-case basis.”
One important consideration is your intention for taking ketamine: If that’s to “heal core traumas and build new neural pathways around circuitry, and you’re trying to build new pathways and heal the underlying depression, anxiety, or PTSD, which can develop into addiction,” then a ketamine consultation may be the next appropriate step.
How Ketamine Now a Mainstream Breakthrough for Depression
Our conversation with Gumpel ended with a mini history of psychiatry in the last four decades, and the promise and significance of ketamine as a recent and much-needed breakthrough:
Basically, if you went to a psychiatrist for depression in 1987, you’d get the same treatment as you do today; yet more people are dying of these diseases of despair, and we’ve not had any new novel treatment for this epidemic that’s plaguing society.
Ketamine works very well. It’s very safe, and it’s a tool used at the discretion of medical doctors to treat people with very hard-to-treat conditions; and it’s a very important tool in the tool kit, and it’s the first of more such tools in this area that we hope will come out.
Here, Gumpel quoted the former director of the National Institute of Mental Health, Dr. Thomas Insel, MD, who said, “Recent data suggest that ketamine, given intravenously, might be the most important breakthrough in antidepressant treatment in decades.”
Meanwhile, ketamine has continued to draw support from highly respected research institutions in the medical and scientific fields, including Harvard University and the University of Toronto; and, Kaiser Permanente and the U.S. Department of Veterans Affairs are now covering IV ketamine.
For anyone battling severe depression or other symptoms, these developments are one more reason to believe that life can get better, treatment can help — and, to not give up.
Interested in whether ketamine may be right for you or a loved one? Call us anytime, day or night, for more information.