Matthew Perry cause of death: Final coroner report released

LOS ANGELES - The Los Angeles County Medical Examiner's Office released their final report on the death of "Friends" star Matthew Perry, noting that the sitcom icon died from "acute effects of ketamine."

"Contributing factors in Mr. Perry’s death include drowning, coronary artery disease and the effects of buprenorphine (used to treat opioid use disorder). The manner of death is accident," the medical examiner noted. 

FOX 11 obtained Perry's official autopsy report, which noted that the actor had a history of chronic obstructive pulmonary disease/emphysema, as well as diabetes. He also had abused drugs in the past but was reportedly clean for 19 months before his death. It also noted that Perry was on ketamine infusion therapy "with the most recent therapy reportedly one and a half weeks before death."

Perry, 54, was found unresponsive floating face down in a hot tub at his Pacific Palisades home on Saturday, October 28. His cause of death was initially listed as ‘deferred’ by the Medical Examiner's Office.

At the elevated levels of ketamine in his body after death, the main lethal effects were likely due to an excessive stimulation of the heart and decreased breathing. The drowning aspect is considered because he likely submerged in the hot tub and lost consciousness due to the effects of the ketamine in his system. 

Buprenorphine, and other opioids, can lead to respiratory depression – when you breathe too slowly or too shallowly, leading to carbon dioxide building up in your blood. Ketamine can result in an increase in blood pressure, which the medical examiner noted in Perry's autopsy.

The heart disease worsened the effects of ketamine on his heart. Buprenorphine, although not at toxic levels, played a role by adding respiratory effects when combined with high ketamine levels.

The levels of ketamine in his peripheral (outer) blood were measured at 3540 ng/ml, and in his central (inner) blood, they were at 3271 ng/ml. To put this in perspective, during monitored surgery or anesthesia, similar levels of ketamine are usually found, ranging from 1000 to 6000 ng/ml.

Perry's death was accidental, resulting from a combination of ketamine, drowning, heart disease, and the effects of buprenorphine. No evidence suggests foul play, and no prescription medications or drug paraphernalia were found near the hot tub or pool.

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All five of Perry's Friends co-stars, Jennifer Aniston, Courteney Cox, Matt LeBlanc, Lisa Kudrow and David Schwimmer, released a joint statement following word of his passing.

"We are all so utterly devastated by the loss of Matthew. We were more than just cast mates. We are a family," they wrote in a statement to People. "There is so much to say, but right now we're going to take a moment to grieve and process this unfathomable loss. 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 appeared in every episode during "Friends'" 10-season run from 1994-2004, making him one of Hollywood's most recognizable actors.