According to the official report, Perry passed away from the "acute effects" of ketamine despite claims that he had been sober for 19 months.
The Friends star, 54, had drowned in the hot tub of his US$8.2 million ($13.2m) Hollywood home on October 28. Alongside the effects of the ketamine and the eventual drowning, which had both contributed to his death, Perry also had traces of an opioid-like drug in his system, as explained in the Los Angeles County Medical Examiner’s 29-page autopsy report released on December 15.
The report provides a sad depiction of Perry’s death and the factors that contributed to it. This came as a significant shock to fans, as friends like co-star Jennifer Aniston were adamant that Perry was "happy" and "healthy" around the time of his death.
Perry had checked into rehab 15 times and spent $14.3m on treatment. Yet despite efforts to manage his struggles, he died of the "acute effects of ketamine" and the effects of buprenorphine (a drug used for opioid addiction treatment), as reported by the coroner.
"Matthew Perry’s cause of death is determined to be from the acute effects of ketamine. Contributory factors include drowning, coronary artery disease and buprenorphine effects (an opioid). The manner of death is accident (drug and drowning related)," wrote Dr Raffi Djabourian, the senior deputy medical examiner.
"No signs of foul play are suspected. At the high levels of ketamine found in his post-mortem blood specimens, the main lethal effects would be from both cardiovascular overstimulation and respiratory depression. Drowning contributes due to the likelihood of submersion into the pool as he lapsed into unconsciousness."
Two interesting details also emerged from the report. Perry was revealed to have been prescribed the drug Mounjaro, which he was using to lose weight. He was also getting regular injections of the male hormone testosterone.
These injections "were causing him to be ‘angry and mean’ for the last couple [of] weeks", said an unnamed female associate who was close to Perry.
Testosterone increases activity in the brain in areas that contribute to aggression; particularly, medical research shows that this specifically increases feelings of anger towards other people or things.
The female associate informed investigators that Perry had changed to a new doctor earlier this year, as outlined in the report. "She last spoke to the decedent [deceased] a few days ago and he seemed fine and was in good spirits. The decedent had a prior history of depression but had told her he would ‘never kill himself’," it says.
"His new doctor of six months stated that since he was in a good mood, his depression was fine and he did not need more treatments."
Perry had been open about his struggles with addiction for many years. He had two therapy sessions per week for 30 years, participated in 6,000 Alcoholics Anonymous meetings, and wrote in his autobiography last year: "It is very odd to live in a world where, if you died, it would shock people but surprise no one."
"Multiple open, empty, half-filled bottles prescribed to the decedent, as well as over-the-counter medications, vitamins, digestive aids and dishes filled with various loose pills, tablets, caplets, candy and breath mints" were found by the detective in Perry’s at-home assistant’s bedroom.
Further around the house, the detective had found "multiple nicotine vaping products," viagra and a hair-loss drug, while nicotine lollipops had been kept in the fridge.
The actor had been undergoing ketamine infusion therapy as a remedy for depression and anxiety. Perry’s last infusion of the controversial treatment had been a week and a half before he was found dead at home.
However, the autopsy report revealed that Perry had 3,540 ng/mL (nanograms per millilitre) of ketamine in his peripheral blood (from a vein) and 3,271 ng/mL in his central blood (from the heart). That is the same amount as what is needed to make someone unconscious under a general anaesthetic.
"The ketamine in his system could not be from infusion therapy, since ketamine’s half-life is three to four hours, or less," explained the report. Traces in the actor’s stomach suggested that Perry had ingested the drug as a pill.
Ketamine use has been on the rise in countries like New Zealand, America and the UK for years. The drug is being increasingly used recreationally as a "party drug" due to its hallucinogenic and euphoric effects, which can make the person taking it feel relaxed and detached from their body.
Yet the powerful tranquiliser is now being used by medical professionals to treat mental health conditions as well as physical pain and discomfort. Ketamine infusion therapy is a relatively new treatment that administers low doses of ketamine to individuals in a controlled environment to help manage various mental health conditions such as PTSD, depression, and anxiety.
Perry had nicknamed himself "The Mattman", in a nod to Batman, within social media posts before his passing. One read: "Sleep well everybody, I’ve got the city tonight."
Kayti Edwards, Perry’s former girlfriend, had said that it was unsurprising there were no illegal drugs found in the house. "He was paranoid and would take them all so there wasn’t any evidence," she claimed.
"That Mattman thing was not something he did when he was sober," Edwards noted as a sign of his relapse.
"I was around him when he was getting high, although I was not getting high with him, and when I said he should cool it with the drugs he would say, ‘No, I’m Mattman’."
"He had a thing with water when he was doing drugs and always did them alone."
The coroner’s investigator, Jennifer Hertzog, spoke to Perry’s friends, family members, staff, and first responders to help understand exactly what happened on his final day, said the autopsy report.
