Stepping into a hot tub in his backyard overlooking the Santa Monica Mountains, Matthew Perry uttered the four words that would eventually lead to his death: "Give me a big shot."
That "big," court records would later show, referred to a large dose of ketamine, a prescription anesthetic and hallucinogen that became popular for its unapproved use in treating depression and anxiety.
It was the actor's third injection that day.
Hours after the fatal dose, the actor from Friends he was found floating face down in a hot tub.
The doctors have him declared dead at the scene, and the coroner determined that ketamine was the primary cause of death.
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Details of Peri's last day of life, October 28, 2023, were revealed in court records following a police investigation that eventually led to the indictment of five people in connection with his death.
The documents offer detailed insight from law enforcement agencies into his decades-long drug addiction and a glimpse into Hollywood's ketamine drug ring.
Doctors and experts told the BBC that the rise in popularity of ketamine in recent years has led to an explosion in the market, with the proliferation of ketamine clinics and online services offering easy access to the drug over a prescription, just as the illegal market has flourished.
"It's very easy to get - either illegally or by prescription," Dr David Mahjubi, president of the American Board of Ketamine Physicians, told the BBC.
"I have celebrities who get prescriptions from me. It's terribly easy, not difficult at all."
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Underground network
Federal authorities said their investigation into Perry's death uncovered an "extensive underground criminal network" of suppliers who distributed large quantities of ketamine throughout Los Angeles.
Federal court filings detail Perry's final months of life and his transition from being treated at a ketamine clinic for depression and anxiety, where a doctor prescribed the drug and monitored for side effects, to an addiction that led him to "unscrupulous doctors" and a network of street dealers. .
Perry has been open about his addiction issues, which go back decades - dating back to when he played Chandler Bing on Friends.
As soon as a drug entered his life, it seemed that he would immediately become dependent on it.
But in the memoir Friends, lovers and the big scary thing, wrote that he finally got sober, and a woman told investigators at the coroner's office that she believed he had been sober for 19 months.
Sometime during that time, he began receiving ketamine infusion therapy.
Experts say Perry's history of addiction helped him quickly become addicted to the drug.
A federal investigation found that during a period of nearly two months before his death, Perry bought dozens of vials of ketamine worth thousands of dollars.
During the three days before his death, his personal assistant injected him with doses of ketamine at least six times a day.
During the investigation, five people were arrested - three of whom have already pleaded guilty to conspiracy.
The group was charged with 23 counts for Peri's death.
- Kenet Ivamasa: Perry's personal assistant with whom he lived under the same roof pleaded guilty to one count of conspiracy to distribute the ketamine that caused his death. He admitted to helping Perry find ketamine and repeatedly injecting him with the drug, including the dose that eventually killed him.
- Doktor Salvador Plasensija: The doctor accused of supplying Perry with large amounts of ketamine, injected him with ketamine on multiple occasions — even outside in the parking lot — and taught his assistant how to administer the doses. He has pleaded not guilty to all charges related to Perry's death.
- Doctor Mark Chavez: A doctor who pleaded guilty to one count of conspiracy to distribute ketamine. He admitted to selling ketamine to Dr. Placencia, as well as the drugs he was diverting from the ketamine clinic.
- Džasvin Sanga, described by law enforcement agencies as the "Ketamine Queen": court records list her as known for working with celebrities and elite clients. She is accused of procuring the drug that ultimately killed Perry. Authorities raided her home and found , as they say, a "drug store", with dozens of bottles of ketamine and thousands of pills. She pleaded not guilty to all counts, including conspiracy to distribute ketamine and distribution of ketamine resulting in death.
- Erik Fleming: A middleman who authorities say procured drugs from Sanga and distributed them to Perry and his assistant. He pleaded guilty to one count of conspiracy to distribute ketamine and one count of distribution of ketamine resulting in death.
'Submissives'
A number of doctors and experts who gave a statement to the BBC for this article spoke about the toxic relationship between celebrities and this drug.
"VIP treatment is usually not the best treatment," Dr Gerard Sanakora, director of the Depression Research Program at Yale University, told the BBC.
"Doctors are people too, and despite taking the Hippocratic Oath, not everyone keeps it," he adds, explaining that doctors can "lose perspective when they have a VIP client," and there are promises of invitations to big parties or donations to research programs or charitable actions.
Dr Mahjubi, who runs two ketamine clinics in California - including one in Los Angeles - told the BBC that when celebrities are your patients, it can be difficult to maintain normal boundaries.
He said that he treated an unnamed celebrity to whom he offered his cell phone number in case of an emergency.
The patient was "constantly trying to ask me for various services" - "hey, refill my prescription - and it was Sunday evening".
"I told him, 'Listen, please email me for anything related to medical issues,' and blocked him," says Dr. Mahdzubi.
He adds that he's seen ketamine become the "favorite" party drug for celebrities, who think it's safer than something like cocaine, which can be mixed with deadly drugs like fentanyl.
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Another Los Angeles-area doctor who works at several pain centers -- another condition for which ketamine is used -- called the spread of ketamine treatment the new "Wild West."
He spoke to the BBC on condition of anonymity to speak openly about the popularity of ketamine, detailing the complex relationship he witnessed between doctors and some celebrities.
Everyone "here wants to be a doctor to the stars," this doctor explained.
Some will even go so far as to offer free treatment or close their own clinic or practice to private access, all in the hope that a celebrity patient will advertise their treatment on social media.
"There are celebrities who switch from doctor to doctor and doctors fight over them," the doctor added, calling it both a "twisted relationship" and a problematic business model.
Many of these stars are used to "not being denied anything," he says.
"If you refuse them, they will go to someone else who will give them what they want."
Being surrounded by "submissives" can have life-changing consequences, says Garrett Brockman, executive director of the Alta Center for Rehab and Detox in Hollywood.
About 20 to 30 percent of his patients work in the film industry.
He adds that he has seen a spike in ketamine addiction, but that it has not overtaken common substance abuse such as alcohol, cocaine and opioids.
"People often get into art because of things they've experienced in life — and that's often trauma," says Brockman.
When you add to that the rather "normalized" drug culture in Los Angeles and the approach that celebrities have, "it's the perfect recipe for addiction," he emphasizes.
The beginning of a new prescription drug epidemic?
A simple Google search for "ketamine prescription" revealed numerous ads for online companies touting the benefits of the "psychedelic therapy" for treating ailments from depression to anxiety to Lyme disease to chronic pain, with some even offering prescriptions for as little as $100 a month to there was a cure.
There is one problem: this drug is not approved for the treatment of these conditions.
The US Food and Drug Administration (FDA) - the regulatory agency charged with approving drugs and ensuring that they are safe and properly labeled - has approved ketamine only for general anesthesia used under the supervision of a physician.
In 2019, the FDA approved a drug in a nasal spray made from ketamine and allowed its use for the treatment of depression, as long as the drug is used with additional therapy and given under direct medical supervision.
The doctor must also monitor the patient for two hours after taking the dose for potential side effects, which include hallucinations, feelings of detachment from reality and increased blood pressure.
But these online clinics have taken advantage of a regulatory gray area to sell prescriptions for unapproved uses of ketamine directly to consumers, experts say.
And while the FDA's advertising regulation restricts pharmaceutical companies that "manufacture, distribute or package a drug," it does not restrict new start-ups, such as online "wellness" clinics.
"It's a very tricky thing - practically a loophole," Dr Sanakora told the BBC.
Two weeks before Perry's death, the FDA warned consumers about ketamine's intended use and stressed that "the absence of monitoring for adverse effects, such as sedation and dissociation, by medical providers may put the patient at risk."
Doctors and experts say the market seemed to boom during the pandemic, when online telehealth services, clinics and home care proliferated.
A pain management doctor, who spoke to the BBC on condition of anonymity, said some of these companies are structured so that they "don't want people to get better" but want to keep them subscribing to prescription drugs to keep the money flowing. to reach them regularly.
"It all got out of hand," he says.
Dr. Sanakora, who has studied and researched how ketamine can be used to treat depression, emphasizes that there is a lot of evidence for the drug's effectiveness. Currently, clinical trials are underway that test the validity of ketamine treatment for depression, which is otherwise resistant to treatment.
But it's still largely unknown why it works, and it comes with some risks, such as stroke and death.
Dr. Sanakora said it's unclear whether overdoses have increased because the federal government doesn't track ketamine-related deaths, although it does for cocaine, heroin and opioid overdoses.
Sometimes, autopsies are not even tested for this drug.
"There's a lot we don't really know," he says.
The head of the DEA, Ann Milgram, explains that this agency has begun to monitor doctors who overprescribe these drugs or prescribe them when there is no need for it.
Speaking to CBS News, the BBC's US media partner, she compared ketamine and its use in Perry's case to the start of the opioid epidemic in the US.
"Unfortunately, this is a tragic arc that we have already seen in the early days of the opioid epidemic, when many Americans became addicted to controlled substances in doctor's offices and through medics, which then turned into street addiction."
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