How did Matthew Perry die? Inside his final months and the ketamine case

Key Points

• Matthew Perry died in 2023 at the age of 54 from the acute effects of ketamine.

• The Friends star’s life and death are explored in the new three-part Netflix documentary The One About Matthew Perry.

• Five people, including two doctors and Perry’s personal assistant, were charged in connection with his death.

It’s been three years since we said goodbye to Matthew Perry, who died on Oct. 28, 2023 at the age of 54.

With the help of his sister Mia Perry Bowick and some of his closest friends, the new Netflix documentary series The One About Matthew Perry recounts the life and untimely passing of the beloved actor. Perry began his acting career in the late ’70s and had a few notable guest spots on ’80s sitcoms, including Silver Spoons and Growing Pains, before landing his breakout role as Chandler Bing on Friends. The NBC sitcom, which premiered in 1994, skyrocketed Perry and his costars to stardom.

As he wrote in his 2022 memoir, Perry had been struggling with substance use disorder since his teenage years. But the public wasn’t aware of his struggles until 1997, when Perry entered a residential rehabilitation program for a Vicodin addiction he developed following a jet-ski accident. “I didn’t know how to stop,” Perry told PEOPLE in 2022. “If the police came over to my house and said, ‘If you drink tonight, we’re going to take you to jail,’ I’d start packing. I couldn’t stop because the disease and the addiction is progressive.”

Over the next several years, the actor continued battling addiction and made multiple attempts at recovery, including in 2001, when he took time away from Friends to enter an inpatient rehabilitation program for Vicodin, alcohol, methadone, and amphetamines. Perry experienced a major health crisis in 2018, when he was hospitalized for a gastrointestinal perforation. It wasn’t until 2022 that he revealed the severity of his condition: Perry was in a coma for two weeks and hospitalized for five months, and he had to use a colostomy bag for almost a year.

“The doctors told my family that I had a two percent chance to live,” he told PEOPLE. “I was put on a thing called an ECMO machine, which does all the breathing for your heart and your lungs. And that’s called a Hail Mary. No one survives that.” But Perry survived, and the experience became part of his long journey toward recovery. In 2022, he published his memoir, Friends, Lovers and the Big Terrible Thing, which he felt could help other people struggling with substance use disorder.

Less than a year later, Perry died. “It is very odd to live in a world where if you died, it would shock people but surprise no one,” the actor wrote in his memoir. As friend and fellow actor David Pressman points out in The One About Matthew Perry, the Friends star wrote quite presciently about his own death.

Below, Entertainment Weekly takes a look back at Perry’s death, how it happened, and the people who were charged in connection with it.

How did Matthew Perry die?

Perry’s body was discovered on Oct. 28, 2023, in the hot tub at his home in Los Angeles. He was pronounced dead at the scene. At the time, there was no evidence to suggest foul play. Nearly two months later, Perry’s cause of death was revealed by the Los Angeles County Medical Examiner’s Office as “acute effects of ketamine.” His death was ruled an accident.

The autopsy report, obtained by EW, lists additional factors that contributed to Perry’s death as drowning, coronary artery disease, and the effects of buprenorphine, a prescription medication used to treat opioid use disorder. The report additionally noted that Perry had been undergoing ketamine infusion therapy, but that the ketamine in his system couldn’t have been from his most recent session, which occurred about a week and a half prior to his death.

According to the report, “the main lethal effects” of ketamine were from “cardiovascular overstimulation and respiratory depression.”

Was Matthew Perry sober before he died?

Yes and no. According to his autopsy report, Perry had reportedly been sober for 19 months before his death. However, subsequent investigations revealed that he had been obtaining and using ketamine outside of his prescribed treatment in the weeks leading up to his death.

Perry told PEOPLE in 2022 that he preferred not to publicly disclose the current length of his sobriety, but that he kept count of the days. “It’s important, but if you lose your sobriety, it doesn’t mean you lose all that time and education,” he explained. “Your sober date changes, but that’s all that changes. You know everything you knew before, as long as you were able to fight your way back without dying, you learn a lot.”

As Perry’s remarks suggest, recovery isn’t necessarily a straight line. The actor experienced periods of sobriety followed by relapse, having dealt with substance use disorder for much of his life.

In the third and final episode of The One About Matthew Perry, the actor’s sister and friends recount the last few years of his life following his 2018 hospitalization. When Perry participated in the Friends reunion special in 2021, his loved ones observed that it was a difficult experience for the actor, who hadn’t acted professionally in front of a camera in quite some time. “He hadn’t been on camera in a while and you can see him struggling in it,” says friend and fellow actor Kevin Pollak. “It’s just tough to watch.”

“I know he was scared, I know that he was fighting for his life. I know that parts of him did not think it was possible for him to live a sober life,” says Mia of this period in Perry’s life. “I started kind of unfortunately thinking of his disease as a terminal illness.”

After the special aired, the internet comments predictably came rolling in, and they were brutal. As they had when Friends was originally airing, several viewers criticized Perry’s appearance and speculated about his health. Though some of the comments were ostensibly couched in concern, many were cruel.

Perry’s friend West Huddleston also recalls receiving a FaceTime call from the actor, who was missing several teeth and in the process of obtaining extensive dental work. “He knew that was going to put him back on opiates for pain and he was deathly afraid of that spiral again,” Huddleston says. “I think Matthew suffered immensely from depression and I think that he really tried to do everything he could to feel okay in his own skin, and was desperate for a solution.”

Perry subsequently turned to ketamine infusion therapy to treat his depression and anxiety.

What is ketamine — and why was Matthew Perry taking it?

Ketamine is an FDA-approved medication that’s traditionally used in hospital settings as a fast-acting anesthetic, according to the Cleveland Clinic. It works by blocking certain signals from a chemical in the brain called glutamate, which helps nerve cells communicate and plays a role in mood, memory, and decision-making. Due to its effects on the brain, ketamine has become increasingly popular in recent years for its off-label use as a treatment for chronic pain and various mental health conditions, including PTSD, anxiety, and treatment-resistant depression.

Those who receive ketamine infusion therapy are administered intravenous doses of the drug by a medical professional during an office visit. Though ketamine can be effective, its antidepressant effects may wear off after days or weeks, requiring repeated treatments. Research into its long-term effectiveness and safety is ongoing, and it’s often used alongside other medications or psychotherapy.

There are conflicting opinions on whether ketamine is an appropriate treatment for people like Perry, who have a history of substance use disorder. Studies have suggested that ketamine may be beneficial in the treatment of alcohol use disorder and other substance use disorders. As Healthline explains, ketamine also carries the risk of misuse and addiction, particularly when used outside medical supervision.

In The One About Matthew Perry, the actor’s sister Mia notes that, as a professional therapist, she was skeptical about using a potentially addictive substance to treat someone with a history of substance use disorder. Ultimately, she supported Perry’s decision because he seemed more “happy” and “present” and was spending more time with their family. None of them suspected that Perry had begun obtaining and using ketamine outside his prescribed treatment.

Who was charged in connection with Matthew Perry’s death, and where are they now?

The Los Angeles Police Department subsequently opened an investigation into Perry’s death to find out who supplied the actor with ketamine. “We were not investigating Matthew Perry as a suspect of any sort,” former U.S. Attorney Martin Estrada tells producers in the Netflix doc. “It was clear from the outset that, if anything, he was the victim of some sort of drug dealing that caused his death.”

On Aug. 15, 2024, Estrada held a press conference to announce criminal charges against five people: doctors Mark Chavez and Salvador Plasencia; TV director and licensed drug counselor Erik Fleming; Jasveen Sangha; and Perry’s personal live-in assistant, Kenneth Iwamasa.

During their investigation, officials determined that Perry began seeking new sources of ketamine in September 2023, about a month before his death. This led him to Chavez and Plasencia, whom Estrada says became “essentially street-level dealers to Mr. Perry, supplying him with ketamine at exorbitant rates.” Text messages obtained by law enforcement showed that Plasencia in particular was “trying to maximize profit” from Perry. In one disturbing message, Plasencia wrote, “I wonder how much this moron will pay” in reference to the actor. According to prosecutors, Plasencia charged Perry $57,000 over approximately two weeks.

Perry and Iwamasa then turned to Fleming, who acted as a go-between, obtaining ketamine from Sangha, whom Estrada describes as “a prolific distributor” who “cultivated this glamorous persona as this ketamine queen.” Officials determined that Sangha supplied the ketamine that contributed to Perry’s death.

Perhaps the most shocking charges were those against Iwamasa, who had known Perry and his family for 30 years and originally worked as the assistant to Perry’s manager, according to Mia. “I met Kenny when I was a child,” Mia says. “When he started working for Matthew after the surgeries to repair his colon, we were all really happy about it. We thought it was a really good fit. Matthew really, really trusted him. I mean, they were together every single day.”

Charged as part of the “network” that supplied Perry with ketamine, Iwamasa “at times was the conduit for obtaining ketamine, at other times was the person who administered the ketamine through injections,” Estrada explains.

“Kenny’s known my brother for 30 years, he knows what he’s battling. The level of betrayal we all felt… he should have known better,” Mia says. “I felt really, like I had been duped, deeply.”

Plasencia pleaded guilty to four counts of ketamine distribution in July 2025 and surrendered his medical license; that December, Plasencia was sentenced to serve 30 months in federal prison, followed by two years of supervised release. Chavez pleaded guilty to one count of conspiracy to distribute ketamine in 2024. He surrendered his medical license, and in December 2025 Chavez was sentenced to eight months of home detention and three years of supervised release.

Sangha pleaded guilty in 2025 to one count of maintaining a drug-involved premises, three counts of distribution of ketamine, and one count of distribution of ketamine resulting in death or serious bodily injury. In April 2026, Sangha was sentenced to 15 years in prison.

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Fleming pleaded guilty to conspiracy to distribute ketamine and distribution of ketamine resulting in death; in May 2026, he was sentenced to 24 months in prison followed by three years of supervised release. That same month, Iwamasa was sentenced to 41 months — a little over three years — in prison after pleading guilty to conspiracy to distribute ketamine resulting in death. Iwamasa admitted that he injected Perry with ketamine on numerous occasions, including three times on the day he died.

Near the end of The One About Matthew Perry, the actor’s close friend David Pressman is asked for his reaction to the charges against Chavez, Plasencia, and the others. Acknowledging the complexity of Perry’s death, Pressman says, “Matthew was a serious addict and he just couldn’t shake it. But with people like that in your orbit who are taking advantage of your addiction and your wealth, I don’t think he stood much of a chance.”

Read the original article on Entertainment Weekly