Matthew Perry's last days were a grim mix of nicotine lollipops, enough ketamine for a general anaesthetic and testosterone jabs that left the Friends icon 'angry and mean'

An autopsy report on Friends star Matthew Perry has revealed the cause of his premature death was probably inevitable after years of his struggle with addictions.

According to the official document, the actor died of an 'acute' overdose of the party drug ketamine, despite claiming to have been clean for 19 months.

The 54-year-old, who drowned in the hot tub at his £4million Hollywood mansion on October 28, also had traces of an opioid-like drug in his system, according to a graphic 29-page autopsy report released by the Los Angeles County Medical Examiner's office on Friday.

While friends, including co-star Jennifer Aniston, had insisted that Perry – who went to rehab 15 times and spent £7million fighting his demons – was 'doing great' in the period before his death, the autopsy paints a grim picture.

Perry died of the 'acute effects of ketamine', according to the coroner, as well as the effects of buprenorphine, an opioid-type drug used to treat opioid addiction.

Dr Raffi Djabourian, the senior deputy medical examiner, wrote: 'Matthew Perry's cause of death is determined to be from the acute effects of ketamine. Contributory factors include drowning, coronary artery disease and buprenorphine effects (an opioid). The manner of death is accident (drug and drowning related).

'No signs of foul play are suspected. At the high levels of ketamine found in his post-mortem blood specimens, the main lethal effects would be from both cardiovascular overstimulation and respiratory depression. Drowning contributes due to the likelihood of submersion into the pool as he lapsed into unconsciousness.'

Intriguingly, the report shows that Perry, who had been prescribed the drug Mounjaro to lose weight, was getting injections of the male hormone testosterone, which, an unnamed female associate claimed, 'were causing him to be 'angry and mean' for the last couple [of] weeks'.

Medical research has shown that testosterone activates areas of the brain which trigger aggression – particularly feelings of anger towards other people or objects.

The report reveals the female associate told investigators that the actor had recently switched doctors. It says: 'She last spoke to the decedent [deceased] a few days ago and he seemed fine and was in good spirits. The decedent had a prior history of depression but had told her he would 'never kill himself'.

'His new doctor of six months stated that since he was in a good mood, his depression was fine and he did not need more treatments.'

The woman stated that the actor's main doctor was an anaesthesiologist whose name, 'Dr Ataoin', is partially redacted in the report. 

A doctor with that name is listed as working in the Los Angeles area, operating at a ketamine clinic offering treatments for addiction and depression. Attempts by The Mail on Sunday to contact the doctor were unsuccessful.

Perry had undergone therapy twice a week for 30 years and attended 6,000 Alcoholics Anonymous meetings. He wrote in his autobiography last year: 'It is very odd to live in a world where, if you died, it would shock people but surprise no one.'

According to the autopsy report, a detective who attended the scene of Perry's death said: 'During my investigation, no alcohol, illicit drugs or drugs paraphernalia were found.'

The report added that in Perry's live-in assistant's bedroom the detective found 'multiple open, empty, half-filled medication bottles prescribed to the decedent, as well as over-the-counter medications, vitamins, digestive aids and dishes filled with multiple various loose pills, tablets, caplets, candy and breath mints.'

Perry's living room contained 'multiple nicotine vaping products', while nicotine lollipops were found in his fridge. Viagra and a hair-loss drug were also found in the house.

The actor had been undergoing controversial ketamine infusion therapy to treat depression and anxiety, but the last infusion had been a week-and-a-half before he was found submerged face-down in his hot tub.

The autopsy details the amount of ketamine that was found in Perry's body: 3,540 ng/mL (nanograms per millilitre) in his peripheral blood (taken from a vein) and 3,271 ng/mL in his central blood (taken from the heart).

The high level of ketamine was about the same amount as would be needed to knock someone out under general anaesthetic. The autopsy report added: 'The ketamine in his system could not be from infusion therapy, since ketamine's half-life is three to four hours, or less.'

Traces of white powder found in the actor's stomach suggested he had taken the powerful tranquilliser in pill form.

In recent years, there has been a boom in ketamine use in America. It is popular as a 'rave drug' because of its hallucinogenic effects, which make the user feel disconnected and 'invincible'.

But thousands of people in the US have undergone legal therapy under its influence and hundreds of ketamine clinics have sprung up across major cities.

Last night, an associate of Perry's, who was in recovery with him, told the MoS: 'Everyone thought he was sober and he insisted he was, but clearly that wasn't the case. We were dreading drugs being found in his system. 

'He pretended to be doing so well but had clearly relapsed. He tried so hard to beat his disease of addiction, but couldn't.'

Perry dubbed himself 'The Mattman', a reference to Batman, in social media posts before his death, writing: 'Sleep well everybody, I've got the city tonight.'

His former girlfriend, Kayti Edwards, said she was not surprised no illegal drugs were found. 'He was paranoid and would take them all so there wasn't any evidence,' she said.

She said Perry calling himself 'The Mattman' was a sign he had relapsed. 'That Mattman thing was not something he did when he was sober.

'I was around him when he was getting high, although I was not getting high with him, and when I said he should cool it with the drugs he would say, 'No, I'm Mattman.'

'He had a thing with water when he was doing drugs and always did them alone.'

Athenna Crosby, a model who had lunch with Perry the day before he died, described him as 'happy and vibrant'.

She said last night: 'I am so sorry to hear this news.'

The autopsy report explains how the coroner's investigator, Jennifer Hertzog, questioned Perry's staff, family members, associates and first responders to piece together a picture of his final day.

Having played the tennis-like racket game pickleball with friends at 11am, the actor was last seen alive at 1.37pm by his assistant, who left the house to run errands.

'At 16:00 hours [4pm] the assistant returned home and found the decedent floating face down in the heated end of the pool.

'The assistant jumped into the pool and moved him into a sitting position on the steps and called 911. Paramedics responded, pulled the decedent out of the pool and onto the grass and pronounced him dead on scene.

'Decedent had a history of drug abuse (clean 19 months), history of smoking, two packs a day (recently quit) and his last ketamine treatment was a week-and-a- half ago.'

Perry was pronounced dead at 4.17pm. Detectives checked the building's electronic security system and found that no one else had entered the property while the assistant was gone.

When police arrived at Perry's house, his body 'was located lying supine in the grass area with his feet towards the pool (south) and his head towards the residence (north). He was wearing black underwear when pulled from the hot tub and was logged as being 5ft 10in tall and weighing 15.4 stone.

Scars from Perry's health woes were visible, including 'horizontal scar tissue' on his stomach from surgery in 2018 when his 'colon exploded' because of opioid abuse.

In his memoir Friends, Lovers And The Big Terrible Thing, Perry chronicled his descent into drug and alcohol addiction after being cast as Chandler Bing on Friends at the age of 24. At one point he was taking 55 opioid pills a day.

While the autopsy report is clinical and graphic, it captures the heartbreak of Perry's devastated family, who raced to his house as news broke of his death.

Under the heading Tissue Donation, it says: 'Tissue donation was not discussed with the family because they were distraught.'

The autopsy found evidence of Perry's years of alcohol abuse, with the actor suffering from 'chronic hepatic congestion: liver' – a precursor to cirrhosis of the liver.

He had hardening in the tissue of his kidneys (nephrosclerosis) and damage to his pancreas (chronic pancreatic fibrosis), likely caused by opioid abuse.

Perry admitted turning to street dealers to buy opioids.

In his memoir he wrote: 'The street pills were something like $75 per pill so I was giving the guy $3,000 at a time. I spent $9million trying to get sober, went to 6,000 AA [Alcoholics Anonymous] meetings, 15 times to rehab and was in detox 65 times.'

Perry was buried at Forest Lawn Memorial Park in the Hollywood Hills at a private service attended by his family and Friends co-stars Jennifer Aniston, Matt LeBlanc, Lisa Kudrow, Courteney Cox and David Schwimmer.

Shortly before his death, the actor said: 'I would like to be remembered as somebody who lived well, loved well, was a seeker. And his paramount thing is that he wanted to help people.'

He added: 'When I die, I don't want Friends to be the first thing that's mentioned. I want that [helping people] to be the first thing that's mentioned.'

Sadly, with the release of the autopsy report, Perry's legacy will forever be overshadowed by the demons he failed to conquer.