Matthew Perry died of the acute effects of the drug ketamine and his death has been ruled an accident, according to a report released by the Los Angeles County medical examiner’s office on Friday.

Several factors contributed to the actor’s death, including drowning, coronary artery disease and an opioid drug called buprenorphine, which is used to treat opioid abuse disorder.

The actor had taken drugs in the past but was “reportedly clean for 19 months,” according to the report.

The coroner said Perry was reported to have been undergoing ketamine infusion therapy to deal with depression and anxiety, and his last treatment was one and a half weeks before his death.

Perry had played pickleball earlier in the day, the report said, and his assistant, who lives with him, found him face down in the pool after returning from errands.

The assistant told investigators Perry had not been sick, had not made any health complaints, and had not shown evidence of recent alcohol or drug use.

Ketamine increasingly used as treatment

Ketamine is a general anesthetic used for medical surgery and is also sold illegally as a party drug. It is increasingly being used as a treatment for depression in low doses.

This has sparked a new industry, with hundreds of clinics popping up in the U.S. in the last decade — and a handful in Canada — offering ketamine as an infusion or injection for experimental treatments of conditions including depression, anxiety and chronic pain. 

The medical examiner said the ketamine levels in Perry’s body were in the range used for general anesthesia during surgery, and would not be explained by his last treatment. The drug typically metabolizes within hours.

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

Stolbach said that using sedative drugs in a pool or hot tub, especially alone, “is extremely risky and, sadly, here it’s fatal.”

The Emmy-nominated Friends actor, who was raised in Ottawa, was found dead at his Los Angeles home in late October. He was 54.

The popular sitcom ran on NBC from 1994 to 2004. During that time, Perry struggled with addiction and sobriety, which he wrote about in his 2022 memoir Friends, Lovers and the Big Terrible Thing.

“I loved everything about the show but I was struggling with my addictions, which only added to my sense of shame,” he wrote. “I had a secret and no one could know.”