Matthew Perry, ketamine and America's doctor-to-dealer pipeline

Unfortunately, the shadowy world of illicit drug use continues to get many of its ideas and pills directly from the world of medicine. Charges related to “Friends” star Matthew Perry’s October death are our most recent example. 

This was certainly true when the opioid epidemic was born and grew, as opium was turned into morphine, which spawned heroin, even as the medical profession was overprescribing opioids for supposed chronic pain. This knee-jerk prescribing fueled a massive amount of illicit use in the first decade of this century.

In the second decade, more physicians became self-aware and more restrictions, including the state of New York’s Internet System for Tracking Over-Prescribing, were put in place to limit and monitor opioid prescribing. But at the same time, fentanyl, another powerful, long-acting opioid conceived to help with chronic pain, including terminal cancer pain, was increasingly co-opted by the drug lords. 

The poppy fields in Mexico have mostly dried up and been replaced by fentanyl. Suppliers of ingredients from China have expanded the fentanyl market, leading to more than 70,000 annual overdose deaths in the U.S.

Thanks to fentanyl, carfentanil, xylazine and other drugs, we have entered a dangerous era where people are fed by increasingly potent drugs made in small labs rather than cooked or distilled from plants.

This concept has now expanded to psychedelics. Even as the medical world studies psilocybin, MDMA and ketamine for the legitimate treatment of severe depression, pain relief and PTSD, the grey and black markets are seizing on these drugs for profit.

Matthew Perry’s tragic death did not occur in isolation but is part of a much larger trend, whereby prescriptions of ketamine from supposed health and wellness centers have reportedly increased by 500 percent since 2017.

Ketamine is a general anesthetic which, when overdosed, can cause disorientation, skyrocketing heart rate and blood pressure, slowed breathing and loss of consciousness. In Perry’s case, the side effects may have been just enough for him to slip below the water line in his hot tub and drown, whereas for others, ketamine can directly kill.

This is why it's so disturbing to learn of an alleged drug ring involving the so-called “Ketamine Queen,” Jasveen Sangha, an emergency room physician Dr. Mark Chavez, who reportedly served as a supplier to an internist, Dr. Salvador Plasencia, who then instructed Matthew Perry’s live-in assistant, Kenneth Iwamasa, to administer the drug to Perry.

What is perhaps most disturbing about this deadly cascade is that feeding the psychological addiction of a rich, high-profile client is not something that occurred in isolation but is part of a much larger market where a potentially dangerous drug is deliberately misused by so-called medical professionals and their consorts.

Consider that ketamine use in general anesthesia or an emergency room setting is now standard, whereas it is still being studied for severe depression or PTSD.

Don’t get me wrong: Treatment by the right providers certainly holds promise in terms of breaking depression cycles due to ketamine’s dissociative and euphoric effects on the brain without the negative side effects and stigma of electroconvulsive therapy. The Food and Drug Administration has thus far approved only esketamine, a nasal spray that is only supposed to be given in a medical setting by experienced healthcare providers.

The idea of drug lords supplying the injectable form of the medication, which is not yet approved for the treatment of depression, to doctors who then teach personal assistants to administer it represents a very dangerous situation that is spiraling out of control.

Illicit drug use is nothing new. But we must heavily police and prevent the hijacking of powerful medicines for untested treatments in order to pad pockets. Our Drug Enforcement Agency certainly has its hands full with ketamine, a highly useful medicine only when the right doctors are administering it for the right reasons.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of “COVID; The Politics of Fear and the Power of Science.”