TL/DR: You can, but it's really hard to do and very, very rare.
Ketamine-assisted psychotherapy (KAP) is a safe and effective treatment for various mental health conditions when used appropriately and responsibly. I have been fortunate and honored to provide KAP both as a prescriber and a therapist to hundreds of clients over the past eight years.
When done in a safe and supportive environment, with appropriate medical and psychological supervision, ketamine is extremely safe and effective.
What happened to Matthew Perry?
I am aware of the increasing concern around ketamine’s abuse and its dangers since the tragic passing of Matthew Perry. As a leader in the field, I want to directly address these concerns with my community.
As more details have surfaced in this case, several individuals including two physicians now face criminal charges (rightfully so). These doctors acted unethically and inappropriately by selling Mr. Perry several vials - one article confirmed that he was sold 10 vials for $11,000 - which costs a doctor about $100 to order at wholesale. There is no question that these physicians acted dangerously and should be held accountable. To knowingly sell a controlled substance to someone with a known history of addiction, and who plans to inject large amounts of ketamine at home without medical supervision, is malpractice at minimum.
However, referring to Mr. Perry's tragic passing as a ketamine “overdose" is simply misleading.
Here's why.
Firstly, the amount of ketamine found in Mr. Perry’s bloodstream was comparable to the amount used for anesthesia, which would be an injection of around 600-1,000 mg. (The actual level is in bloodstream was 3,540 ng/ml). This number is so high that when it was revealed months ago, my colleagues and I couldn't imagine how someone could get to that level in one sitting. Here's why: you would fall asleep from the sedative effects of ketamine long before you got anywhere near the level of overdose.
So, yes, the amount of ketamine found in his bloodstream is dozens of times higher than anyone should have through self-administration at home without medical supervision. However, it is still far lower than the overdose limit, which is approximately 4,500 mg.
You have to understand, ketamine is not heroin. It does not cause respiratory depression - causing one to stop breathing - except in very high doses or in people with serious underlying heart or lung conditions.
This is why it was so revolutionary when first synthesized in 1964: because it did not have the same respiratory - and therefore overdose - risk as other opioid-based sedatives. In other words, ketamine was specifically formulated as a safer alternative to other dangerous-in-high-doses anathesia medications.
Another reason it is difficult to overdose is the pure amount of liquid that would be required to be injected within a relatively short period of time in order to truly overdose. It would take approximately 45 milliliters to be injected of a 100 mg/mL solution to reach dangerous levels in a healthy individual. As a reference, a vaccine shot is about 0.2 mL. A B12 shot is about 1 mL. I hope you're putting together how nearly impossible it is to inject yourself with 45 mL of fluid, unless you have help, an IV, or are doing so with great intention and planning. By the time you injected half that amount, you would be fall asleep and be unable to inject the remainder. In other words, the chance of an accidental overdose is astronomically low.
Well, what we recently discovered is that Mr. Perry did have help. He was injected several times throughout the day that day by his assistant. Ketamine has a half-life of 2-4 hours, which means it's out of your system pretty quick, BUT with repeated injections it can build up in your system. With this information that he was receiving repeated injections, more is starting to make sense.
To back up for a second to answer the question of safety, we need to put this dosage into context: the amount of ketamine we use in mental health treatment is between 25-100 mg (referred to as “low-dose ketamine”). (For my clients reading this who are saying, "Wait a minute, I took 300 mg!" What you took was in oral form, which is in the ballpark of a 50-75 mg injection.)
Therefore, an overdose amount would be 45 times higher than the amount of ketamine used in mental health treatment.
Unfortunately, Mr. Perry had underlying health conditions that made him high-risk for ketamine treatment to begin with. On top of the strain on his heart and lungs from high doses of ketamine injected several times throughout the day, he also had other sedative medications in his system which do cause respiratory depression, Finally, he made the dangerous decision of getting in a body of water on sedatives, which I believe ultimately took his life. As we put the pieces together, it is clear that a tragic series of events culminated in his passing. However, it was not strictly a ketamine overdose.
While ketamine undeniably contributed, Mr. Perry’s passing is a stark reminder of the dangers of medication misuse and potential for addiction. However, it does not reflect the therapeutic use of ketamine when used responsibly and should not deter individuals from getting the help they need.
What’s the benefit of doing ketamine-assisted therapy?
Ketamine can reduce symptoms of depression and suicidal ideation within hours, offering a potential lifeline for those in crisis. The combination of ketamine with psychotherapy is believed to enhance these effects, helping patients process and integrate their experiences in a therapeutic context.
If you need help, please reach out.
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