Matthew Perry’s Cause of Death Has Been Revealed

Matthew Perry

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Here’s what we know about the 54-year-old’s passing.

Matthew Perry, the actor best known for playing Chandler Bing in Friends, died Oct. 28, 2023, at age 54. The heartbreaking news came as a shock to Perry’s co-stars, colleagues, loved ones, and fans, but now, nearly two months since his death, we’re getting more insight into what happened that tragic day.

How did Matthew Perry die?

The LA Times reported that Perry was found unresponsive in a hot tub at his home in Los Angeles, and authorities responded at about 4 p.m. to a “water emergency.” Perry was declared dead on the scene.

A toxicology report released Dec. 15 by the Los Angeles County Medical Examiner’s Office pointed to “the acute effects of ketamine” as a major factor in Perry’s passing. As the medical examiner wrote, the ketamine in his system caused cardiovascular overstimulation and respiratory depression. Other factors listed in the report as contributing to his death include drowning, coronary artery disease, and the effects of buprenorphine, a medication approved by the FDA to treat Opioid Use Disorder.

While ketamine is sometimes used as a recreational drug, it’s also used as a treatment for depression. According to the toxicology report, the actor had been undergoing ketamine infusion therapy for his depression less than two weeks before he died — but, as TMZ points out, the report also states that the ketamine in Perry’s system “could not be from that infusion therapy, since ketamine’s half-life is 3 to 4 hours, or less.”

The medical examiner’s findings state that, according to interviews, Perry had been sober for nearly two years before he died, and the investigation found no evidence of alcohol, cocaine, methamphetamine, heroin, fentanyl, or PCP in his system. The report does note that Perry suffered from COPD and diabetes and smoked two packs of cigarettes a day, but the smoking wasn’t listed among the factors that contributed to his death.

What has Perry said about his health struggles?

Perry struggled with addiction for years and went to rehab several times. In 1997, he got into a jet ski accident and was prescribed Vicodin. He later wrote in his memoir, which was released in November 2022, that at one point he was taking up to 55 Vicodin a day. He also struggled with alcohol and in 2000 was hospitalized for alcohol-related pancreatitis. He wrote in his memoir that he visited rehab 15 times and has said he spent anywhere from $7 million to $9 million on his sobriety journey.

He had a near-death experience

Late last year, the Friends star sat down with PEOPLE ahead of the release of his memoir, Friends, Lovers, and the Big Terrible Thing. He opened up about the near-death experience that inspired him to write about his life and battles with addiction. He revealed that when he was 49, he suffered a gastrointestinal perforation after his colon burst due to opioid use. He ended up in a coma for two weeks fighting for his life.

“The doctors told my family that I had a 2 percent chance to live,” he told PEOPLE in October 2022. “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.”

He said that the same day, four other people were put on an EMCO machine, and only he survived. He wondered about his miraculous recovery: “Why was I the one? There has to be some kind of reason.”

Perry’s road to recovery was not an easy one — he spent five months in the hospital and had to use a colostomy bag for nine months. He said that experience reframed his addiction: His therapist told him, “The next time you think about taking Oxycontin, just think about having a colostomy bag for the rest of your life.” He said after hearing that, “A little window opened and I crawled through it and I no longer want Oxycontin anymore.”

He broke eight ribs after another brush with death

In his memoir, Perry recounted the time he was supposed to appear in the 2021 film Don’t Look Up, but had to pull out of the project after suffering eight broken ribs. He wrote that he was staying at a rehab center in Switzerland when he was given Propofol before a surgery to help with his stomach pain. Unfortunately, the Propofol interacted with the hydrocodone that was already present in his body and caused his heart to stop beating.

“Apparently, the propofol had stopped my heart. For five minutes. It wasn’t a heart attack — I didn’t flatline — but nothing had been beating,” Perry wrote in his memoir.

“I was told that some beefy Swiss guy really didn’t want the guy from Friends dying on his table and did CPR on me for the full five minutes, beating and pounding my chest,” he wrote. The man performing CPR broke eight of his ribs while saving his life. Perry reflected on the event, writing, “If I hadn’t been on Friends, would he have stopped at three minutes? Did Friends save my life again?”

His co-stars helped him through his issues

When writing about his heart stopping, Perry was alluding to the fact that his Friends co-stars were aware of his battles with addiction and tried to help him in various ways. He wrote in his memoir that he was never high while filming Friends, but being hungover did impact his performance. He recounted one instance where Matt LeBlanc prevented him from missing a cue. “One time, in a scene in the coffeehouse when I’m dressed in a suit, I fell asleep right there on the couch, and disaster was averted only when Matt LeBlanc nudged me awake right before my line,” he wrote. “No one noticed, but I knew how close I’d come.”

In 2002, he told the New York Times that his Friends castmates “all tried to help him” with his addiction, but he was “in denial about his problems.”

“Hard doesn’t even begin to describe it,” Lisa Kudrow told the NY Times at the time. “We were hurting a lot. Matthew is one of the funniest people I’ve ever met in my life. He’s charming and hilarious. Most of our hard laughs came from Matthew.”

He reflected on his friends’ support to PEOPLE in 2022. “It’s like penguins,” he told the outlet. “Penguins, in nature, when one is sick, or when one is very injured, the other penguins surround it and prop it up. They walk around it until that penguin can walk on its own. That’s kind of what the cast did for me.”

Matthew Perry’s last Instagram post

Since the news broke, fans have been flocking to Perry’s last Instagram post to pay tribute to the beloved actor. The post is a shot of Perry in what appears to be his jacuzzi. The caption reads, “Oh, so warm water swirling around makes you feel good? I’m Mattman.”

“Thank you for all the laughter and joy you brought into the world,” commented one fan. “We all lost a Friend today,” wrote another.