Ketamine has been in the news quite a bit since the death of a beloved actor and amazing person who used his personal struggles with depression and substance abuse to help so many others understand the stigma and barriers to treatments that millions of people suffer every single day. Since the autopsy report and cause of death for Matthew Perry has been made public, there has been some negative light on the use of Ketamine therapy for treatment; however, most professionals in the field acknowledge that IV ketamine infusions under the guidance and direct care of healthcare professionals remains a very safe and effective treatment. The staff and providers at KetAssure would like to take this space and a few minutes of your time to break down the benefits and risks of the various methods of treatment through the use of a multitude of different forms of ketamine, be it intravenously, intramuscularly, intranasal, under the tongue, or by mouth. We will also attempt to briefly discuss the details surrounding Matthew Perry’s death from our own review of various news sources, his public autopsy, and our personal knowledge of the factors that likely lead to his demise. And lastly, we will provide our take on cost, benefit, safety, and calls to FDA approval, insurance approval, and increased oversight and regulation to help ensure others do not meet the same untimely end.
Matthew Perry’s official autopsy report suggests that his cause of death was ultimately due to the cardiovascular and respiratory effects of Ketamine. So how does Ketamine lead to cardiovascular and respiratory problems? Well, this medication may cause increases in blood pressure, and thereby increase demand on the cardiovascular system. With a known history of coronary artery disease and a postmortem finding of 75% blockage in his LAD (one of the 3 main arteries in the heart), his heart was likely not equipped to handle the increased demand of such significant doses (his blood levels were between 3 & 10 times what is typical for those receiving low-dose ketamine therapy for mental health). "At the high levels of ketamine found in his postmortem blood specimens, the main lethal effects would be from both cardiovascular overstimulation and respiratory depression". Respiratory effects include respiratory depression that comes with any anesthetic agent, albeit these effects are noted to be observed much less with Ketamine. Ketamine’s respiratory effects usually come at a much higher dose (10-15 times higher) than what is typically given for psychiatric conditions. Additionally, he was taking Buprenorphine (Suboxone), benzodiazepines (Ativan and clonazepam), Seroquel (a non-benzodiazepine anxiolytic that can often cause somnolence or fatigue) which likely potentiated his ketamine effects. Combine the sedative factors, dissociation that comes with ketamine treatment, respiratory depression, and cardiovascular compromise, and the fact that he was in a hot tub or pool at his home without supervision, there was a perfect storm of conditions that would have been difficult for anyone to survive.
Ketamine therapy has numerous facets and caveats, and in a world that frequently puts the average internet surfer on information overload. It is vitally important to understand the differences and carefully navigate these options when choosing the best method for each individual. The various forms of treatment are all aimed at the same goal of treating a myriad of mental health ailments, migraine headaches, and alcohol dependence. Ketamine is NOT, however, intended or proven at all effective with treating or controlling substance abuse disorder. Ketamine therapy has a long track record of being safe and effective when administered under close monitoring by a medical professional. At home therapy, although slightly cheaper and much easier to obtain, is not as safe and far less effective than IV infusion therapy. A quick internet search will show an ever amassing quantity of research studies to attest to the benefits AND safety of ketamine therapy, particularly the IV infusions therapy, however, there is still needed much work on regulation and, perhaps, FDA investigations into label expansion. Until then, while slightly more costly, we strongly believe the extra small amount of upfront money necessary for IV infusion is well worth the added safety and efficacy. For your reference, the various forms of therapy and their effects are outlined below:
The Various Ketamine Treatment Options
Compounded oral treatments:
Onset of action: 1-2 hours.
Bioavailability: 15-25%
Risk of treatment: Much less effective (essentially NOT effective at all). Typically, these doses are performed at home, so monitoring is much less rigorous and can lead to dangerous spikes in BP, CV compromise, and/or even respiratory depression not to mention personal injuries that may arise from dissociation and/or sedation. This treatment modality also has the highest risk or potential for abuse.
Benefits of modality: Cheaper, easier, and completed in the comfort of home.
Cost of therapy: About $80 per month (tablets taken nightly). No loading doses, but far less effective.
Compounded sublingual troches:
Onset of action: 30-40 minutes.
Bioavaibilsty: 30%
Risk of treatment: Much less effective. Typically, these doses are performed at home, so monitoring is much less rigorous and can lead to dangerous spikes in BP, CV compromise, and/or even respiratory depression not to mention personal injuries that may arise from dissociation and/or sedation.
Benefits of modality: Cheaper, easier, and completed in the comfort of home.
Cost of therapy: About $100 per month (troches taken 3x weekly). No loading doses, but less effective.
Rectal Suppositories:
Onset of action: 40-45 minutes
Bioavailability: 25-40% (varies)
Risk of treatment: Typically, these doses are performed at home, so monitoring is much less rigorous and can lead to dangerous spikes in BP, CV compromise, and/or even respiratory depression not to mention personal injuries that may arise from dissociation and/or sedation.
Benefits of modality: Cheaper, easier, and completed in the comfort of home.
Cost of therapy: About $150 per month (suppositories 3x weekly). No loading doses, but less effective.
Nasal sprays (Spravato):
Onset of action: 15 minutes
Bioavailability: 40-50% (varies)
Risk of treatment: Standardized dosing & still requires 2 hours of monitored observation.
Benefits of modality: The only ketamine modality that is currently FDA approved, & therefore, more likely to be covered (at least in part) by insurance.
Cost of therapy: About $1000 (but typically is covered by insurance at 80%, so each treatment is about $200 out of pocket, and these sprays occur every 2 weeks).
Intramuscular Injections:
Onset of action: 5-10 minutes
Bioavailability: 93%
Risk of treatment: Needle sticks. Full dose is administered and cannot be adjusted once injected. Overdose is a risk, & requires 2 hours of monitored setting observation. Given the fast peak, IM ketamine is often administered in 2 injections about 30-45 minutes apart (these two injections count as one treatment session).
Benefits of modality: Cheaper versions from compounding pharmacies. Rapid onset. Slightly cheaper, & still very effective.
Cost of therapy: About $200 per treatment. (Typically performed weekly).
Intravenous Infusions:
Onset of action: 1 minute
Bioavailability: 100%
Risk of treatment: Requires IV access and monitored setting.
Benefits of modality: Most effective treatment available. After loading infusions, ongoing costs are much more affordable.
Cost of therapy: About $400-800 per treatment (Requires 6 treatments for “loading”).
Nasal and IV Ketamine require oversight and monitoring from a licensed provider and nursing staff. The IV supplies and cost of labor increases the cost, but also sharply increases the safety profile and decreases risk. Oral, SL, and injectable ketamine is often administered at home without ANY supervision, and typically without even monitoring of vital signs, which, while somewhat cheaper, is much more dangerous. These methods are far less effective as well due to poorer rates of absorption, metabolism, and limitations associated with compounding medications. Even intranasal ketamine (insurance approved) is marked up to the point where copays often come close to the cost of “off label” IV treatments after appeal and reimbursements from insurance companies.
“Friends” costars can attest that Matthew Perry was happy, quit smoking, was doing well with his sobriety journey, and he was getting himself healthy. In fact, one source quoted Jennifer Aniston recalling her phone conversation with him just hours before his death; “He was not in pain. He wasn’t struggling. He was happy.” These statements lead one to question if his lifestyle improvements are a testament to the astounding benefits of Ketamine therapy? The release of the autopsy for Matthew Perry has opened the eyes of many benefactors, financiers, naysayers, and sensationalists alike who are all asking the same questions: What role does this potentially dangerous medication have in the world of psychiatric treatment, and how can we make it safe, affordable, and still keep it effective and available? The coming days, months, and years will assuredly bring some answers and, hopefully, solutions to these very important questions.
KetAssure IV Infusion Clinic
1200 N 4th St.
Effingham, IL 62401
(217)-636-1444
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