The world basically stopped for a second on October 28, 2023. We all saw the headlines: Matthew Perry, the man who gave us Chandler Bing and arguably the best comedic timing of a generation, was found dead. He was only 54.
He was found in the "heated end" of his pool—basically a hot tub—at his home in Pacific Palisades. At first, everyone was just stunned. Then the questions started. How does a man who was reportedly 19 months sober, who had just spent the morning playing pickleball, and who seemed to be finally finding peace, just... die?
Honestly, the initial shock turned into a complicated investigation that revealed a lot more than just a tragic accident. It wasn't just a simple drowning.
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How did Matthew Perry die? The official breakdown
When the Los Angeles County Medical Examiner finally released the report, the technical term used was the "acute effects of ketamine." That sounds clinical, but the reality is much heavier. While the report listed drowning as a factor, it was a secondary one. Basically, the ketamine in his system caused him to lose consciousness. If you're in a hot tub and you pass out, you can't keep your head above water.
But here’s where it gets weird. Perry was actually undergoing legal ketamine infusion therapy for depression and anxiety. However, his last medical session was a week and a half before he died. Ketamine has a half-life of only a few hours. It’s gone from the body pretty fast.
The medical examiner was blunt: the levels found in his blood were equivalent to what you’d see in a patient undergoing general anesthesia in a hospital. There is no way that came from a doctor's appointment ten days prior.
The lethal cocktail in his system
It wasn't just the ketamine. The autopsy found a few other contributing factors that created a "perfect storm" for a cardiac event or respiratory failure:
- Buprenorphine: This is a medication used to treat opioid addiction. Perry had it in his system at therapeutic levels. While it's safe when used right, it’s a central nervous system depressant. When you mix that with high-dose ketamine, your urge to breathe starts to fade.
- Coronary Artery Disease: His heart wasn't in great shape. The report noted "moderately severe" clogging in his arteries.
- The Pool Environment: Heat from a hot tub dilates blood vessels and can lower blood pressure. Combined with a dissociative drug, it was a recipe for disaster.
The investigation into the "Ketamine Queen" and the doctors
For months, we thought it was just a tragic relapse. But in August 2024, the story took a dark turn. The DEA and LAPD unsealed an indictment that exposed a "broad underground criminal network."
It turns out, Matthew Perry had been preyed upon.
When his regular doctors refused to increase his dosage, he went looking elsewhere. He found people willing to exploit his addiction for a payday. Federal prosecutors charged five people, including two doctors and Perry's own live-in assistant, Kenneth Iwamasa.
One of the doctors, Salvador Plasencia (known as "Dr. P"), allegedly wrote in a text message: "I wonder how much this moron will pay." He was selling Perry vials of ketamine that cost $12 for upwards of $2,000.
Then there’s Jasveen Sangha, famously dubbed the "Ketamine Queen" of North Hollywood. Prosecutors allege she was the one who supplied the specific batch that killed him. Her house was described as a "drug-selling emporium."
The role of Kenneth Iwamasa
This might be the saddest part. Perry’s assistant, a man who lived with him and was supposed to look out for him, was the one administering the shots. Iwamasa admitted to injecting Perry multiple times on the day he died. He had no medical training.
Think about that for a second. On October 28, Iwamasa gave Perry at least three shots of ketamine. The last one was right before Perry got into the water. Iwamasa then went to run errands. When he came back, he found Perry face down.
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Why this case changed how we look at ketamine
Ketamine has become a "miracle drug" lately for people with treatment-resistant depression. It’s saved lives. But Perry’s death highlighted a massive, unregulated "wild west" in the medical community.
Experts like Dr. Andrew Stolbach from Johns Hopkins have pointed out that while the drug is safe in a controlled clinic with a monitor, it is incredibly dangerous when taken "off-book" at home. Especially alone. Especially in water.
The nuance here is important:
- Ketamine isn't the villain. It's a tool for mental health.
- Unregulated access is the killer. When doctors start acting like dealers, the safety net disappears.
Perry’s heart was already weakened by years of drug abuse—something he was incredibly honest about in his memoir, Friends, Lovers, and the Big Terrible Thing. He had survived a burst colon, a coma, and dozens of surgeries. He was a fighter. But even a fighter can't survive general-anesthetic-level drugs while sitting in a hot tub.
Understanding the risks of "off-label" therapy
If you or someone you know is looking into ketamine therapy, Perry’s story is a sobering reminder of why clinical supervision is non-negotiable.
The tragedy of how Matthew Perry died isn't just that he relapsed; it’s that he was surrounded by people who saw his struggle as a business opportunity. He wanted to get better. He was trying to find a way to live with the "Big Terrible Thing."
Actionable Insights for Navigating Mental Health Treatments:
- Always use a certified clinic: If a doctor offers to give you "take-home" vials of injectable ketamine, that is a massive red flag. Standard of care for infusions requires in-office monitoring of your vitals.
- Disclose everything: Perry was on Buprenorphine. Mixing substances that affect your breathing is where the highest risk lies. Be 100% honest with your providers about every pill or supplement you take.
- The "Alone" Rule: Never use dissociative or sedative medications near water or while alone.
- Check the credentials: If you're seeking help for addiction or depression, ensure your provider is board-certified and operates out of a legitimate medical facility, not a "stash house" or through a middleman.
Matthew Perry wanted to be remembered for helping people stay sober more than he wanted to be remembered for Friends. By understanding the specifics of his passing, we can at least respect that wish by taking the dangers of unregulated drug use seriously.