According to the Los Angeles County Medical Examiner’s Office, “Friends” actor Matthew Perry died from “the acute effects of ketamine.”

The medical examiner said in the autopsy report that Perry, 54, also drowned in “the heated end of his pool.”

However, drowning was a secondary factor in his death.

Contributing factors included drowning, coronary artery disease and the effects of buprenorphine (used to treat opioid use disorder).

“Perry had been undergoing ketamine infusion therapy prior to his death, reportedly for depression and anxiety,” Variety reports.

“At the high levels of ketamine found in his postmortem blood specimens, the main lethal effects would be from both cardiovascular overstimulation and respiratory depression,” the toxicology report read, according to Variety.

Per Variety:

Perry died on Saturday, Oct. 28, 2023. Authorities arrived at his home in Los Angeles around 4 p.m. and found him in a hot tub, according to the Los Angeles Times. There were no signs of foul play or drugs at the scene. First responders were called for a cardiac arrest, according to TMZ, which first reported the news.

Perry was best known for playing the hilarious, sarcastic Chandler Bing on “Friends” in the ’90s and early 2000s. He starred in more than 200 episodes of the NBC sitcom across 10 seasons.

“We are all so utterly devastated by the loss of Matthew. We were more than just cast mates. We are a family. There is so much to say, but right now we’re going to take a moment to grieve and process this unfathomable loss,” Perry’s “Friends” cast members Jennifer Aniston, Courteney Cox, Lisa Kudrow, Matt LeBlanc and David Schwimmer wrote in a statement following the news of his death. “In time we will say more, as and when we are able. For now, our thoughts and our love are with Matty’s family, his friends, and everyone who loved him around the world.”

Perry’s “Friends” co-stars would each go on to share personal tributes to the actor, with Aniston exclusively telling Variety that she texted with him on the day of his death.

“He was happy. He was healthy. He had quit smoking. He was getting in shape. He was happy — that’s all I know,” Aniston said. “I was literally texting with him that morning, funny Matty. He was not in pain. He wasn’t struggling. He was happy.”

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The Associated Press added:

People close to Perry told investigators that he was undergoing ketamine infusion therapy, an experimental treatment used to treat depression and anxiety. But the medical examiner said the levels of ketamine in Perry’s body were in the range used for general anesthesia during surgery, and that his last treatment 1 1/2 weeks earlier wouldn’t explain those levels. The drug is typically metabolized in a matter of hours.

The report says coronary artery disease and buprenorphine, which is used to treat opioid use disorder, also contributed.

The amount of ketamine detected “would be enough to make him lose consciousness and lose his posture and his ability to keep himself above the water,” said Dr. Andrew Stolbach, a medical toxicologist with Johns Hopkins Medicine who reviewed the autopsy report at the request of The Associated Press.

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“Using sedative drugs in a pool or hot tub, especially when you’re alone, is extremely risky and, sadly, here it’s fatal,” said Stolbach, who noted that both ketamine and buprenorphine can be used safely.

Perry was declared dead after being found unresponsive at his home in the Pacific Palisades area of Los Angeles. Investigators performed the autopsy the following day.

Read the full toxicology report HERE.

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