The Los Angeles County Department of Medical Examiner determined that Matthew Perry died from the acute effects of ketamine and classified his death as an accident. The fatal exposure described in federal case records involved injections outside professional medical supervision—not the ketamine infusion treatment Perry had received earlier.
What caused Matthew Perry’s death?
On December 15, 2023, the Los Angeles County Department of Medical Examiner said the cause of death for 54-year-old Matthew Langford Perry was the acute effects of ketamine. The examiner classified the death as an accident. The autopsy also identified drowning as a contributing factor, along with coronary artery disease and buprenorphine.
The autopsy recorded postmortem ketamine concentrations of 3,540 ng/mL in peripheral blood and 3,271 ng/mL in central blood. Those are measurements taken after death, not therapeutic doses or guidance for medical treatment.
Was Perry receiving ketamine therapy, and was it connected to the fatal exposure?
Yes. The autopsy says Perry had been receiving ketamine infusion therapy, reportedly for depression and anxiety. His last known treatment was about a week and a half before his death. The medical examiner concluded that this timing did not explain the high ketamine level found at death.
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Federal case records describe a separate fatal exposure. In a May 27, 2026 update, the U.S. Department of Justice reported that Perry’s live-in personal assistant, Kenneth Iwamasa, admitted to injecting Perry with at least three shots of ketamine on October 28, 2023, using ketamine obtained from Jasveen Sangha. DOJ reported that Iwamasa pleaded guilty to conspiring to distribute ketamine resulting in death and serious bodily injury and was sentenced to 41 months in federal prison.
On April 8, 2026, DOJ reported that Sangha was sentenced to 180 months (15 years) for federal drug offenses, including distribution of ketamine resulting in death or serious bodily injury. DOJ’s December 2025 sentencing release said physician Salvador Plasencia did not provide the ketamine that caused Perry’s death. These are descriptions of the federal case and its outcomes, not a finding that supervised ketamine treatment caused Perry’s death.
What does “ketamine therapy” mean?
The phrase can refer to different drugs, formulations, and settings. Ketamine is an FDA-approved medical product for anesthesia, but FDA has not approved it to treat psychiatric disorders. A clinician may prescribe a drug off-label within the practice of medicine; that does not mean FDA has approved it for that particular condition.
Esketamine nasal spray, sold as Spravato, is a different medicine with FDA approval for specified adult depression indications. Compounded ketamine products are another category: FDA has warned about potential risks when they are used for psychiatric disorders, including oral formulations. These distinctions matter because approval, formulation, administration, and oversight are not interchangeable.
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Repair common Windows errors and clear accumulated junk for a smoother, more stable PC - no reinstall needed.Free scan · no reinstall| Approach | Drug and regulatory status | Setting and oversight described by the sources |
|---|---|---|
| Ketamine anesthesia | Ketamine is FDA-approved as an anesthetic; psychiatric treatment is not an FDA-approved indication. | The supplied official sources do not set out a single administration protocol for all anesthetic use. |
| Off-label ketamine treatment | Ketamine may be prescribed off-label; this is not FDA approval for a psychiatric indication. | Practice and supervision depend on the care provided. The sources here do not establish one standard protocol or comparative efficacy. |
| Spravato (esketamine) nasal spray | A distinct FDA-approved medicine for specified adult depression indications. | Administered in a certified healthcare setting through the Spravato REMS, with monitoring for at least two hours after a dose. |
| Compounded ketamine products | Compounded products are not the same as FDA-approved Spravato; FDA has warned of potential risks when they are used for psychiatric disorders. | The cited FDA warning does not establish one universal protocol for compounded products. |
| Fatal exposure described in Perry’s federal case | DOJ reported injections of ketamine obtained from Sangha; it was not described as Perry’s earlier infusion treatment. | DOJ’s account describes injections by Iwamasa outside professional medical supervision. |
Is ketamine FDA-approved for depression?
No. FDA says ketamine is not approved for treating psychiatric disorders. Off-label prescribing is distinct from FDA approval of a drug for a specific condition.
Spravato is FDA-approved for treatment-resistant depression in adults, and for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior when used in conjunction with an oral antidepressant. Its labeling says effectiveness for preventing suicide or reducing suicidal ideation or behavior has not been demonstrated.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.What safety monitoring does Spravato require?
Spravato carries warnings for sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors. FDA-approved labeling instructs: “Monitor patients for at least two hours after administration.” The treatment is administered in a certified healthcare setting under the Spravato REMS.
Those requirements apply to Spravato and should not be treated as a description of every ketamine product or treatment arrangement. FDA has separately warned about potential risks from compounded ketamine products used for psychiatric disorders.
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What can this case establish about ketamine treatment?
The medical examiner’s finding and federal case records distinguish Perry’s reported earlier infusions from the later injections described in the criminal case. They do not establish how effective ketamine treatment is for depression, who is an appropriate candidate, or what long-term outcomes to expect. Nor do the reported sentences measure the safety of medically supervised care. Those questions require clinical evidence beyond the death investigation and prosecution record.
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