The Los Angeles County medical examiner’s office on Friday ruled the drowning death of Friends star Matthew Perry in October was due to “the acute effects of ketamine.” The 54-year-old Perry battled addiction for decades and detailed in his memoir how he was using ketamine as part of his treatment for depression and anxiety.

Now Perry’s death, which was also determined to be an accident, has put greater attention on ketamine, a drug that has proven to be an effective mental health treatment but poses risks in recreational and unregulated settings.

Ketamine’s journey to health aid

The drug’s origins date to the 1970s as an injectable anesthetic for humans and animals. It took a circuitous route to becoming a breakthrough treatment for mental health.

• In the 1990s, ketamine—known as “Special K”—emerged as a popular party drug thanks to its hallucinogenic qualities.
• In 1999, it became a Schedule III nonnarcotic substance under the Controlled Substances Act. Schedule III drugs are defined by the Drug Enforcement Administration as having a “moderate to low potential for physical and psychological dependence.”
• In 2006, researchers at the National Institutes of Health showed that an intravenous dose of ketamine could relieve severe depression in a matter of hours.
• In 2019, the FDA approved a nasal spray called esketamine, which is derived from ketamine and used for treatment-resistant depression.

The main difference between medicinal and recreational use of ketamine is the dosage, which is much higher when it’s used as an anesthetic or illicitly.

The dangers of home use

Esketamine must be administered by a healthcare professional in a clinical setting. Perry’s autopsy report said the ketamine in his system could not have been from his last known ketamine therapy session, which was about a week and a half before he died.

Online providers started prescribing ketamine for home use during the pandemic, thanks to relaxed federal rules on remote prescriptions. Although ketamine overdoses are rare, the drug’s ability to render a subject unconscious with too high of a dose without supervision has led to accidental deaths.

Big picture: Investors have written big checks to startups aiming to treat mental illness with psychedelics, and Silicon Valley elites such as Elon Musk reportedly use ketamine, LSD, and other mind-expanding drugs recreationally. Dr. Gerard Sanacora, director of Yale University’s depression-research program, told the WSJ that Perry’s death “should be a wake-up call that ketamine needs to be used appropriately.”—DL

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Trump uses Nazi-era rhetoric to attack migrants. On the campaign trail in New Hampshire, former President Trump said migrants were “poisoning the blood of our country,” echoing words Adolf Hitler used in Mein Kampf, scholars said. Trump’s escalating rhetoric on immigration came as lawmakers scrambled to work out a deal on border security, which Republicans are demanding as part of a broader package that would send tens of billions of dollars in military aid to Ukraine. The clock is ticking before senators leave town for the holiday break.

​​Israel’s European allies call for a truce. The foreign secretary of Britain and the foreign minister of Germany wrote a joint article in the Sunday Times calling for a “sustainable cease-fire” in the Israel—Hamas war, stopping short of the “immediate” truce called for by France, which expressed concern for the heavy civilian death toll in Gaza. Israel is reeling from the deaths of three hostages who the IDF fatally shot while they were waving a white flag, and protesters in Tel Aviv urged the government to push for another hostage-release deal. Israeli Prime Minister Benjamin Netanyahu, who will receive a visit from US Defense Secretary Lloyd Austin today, has vowed to “fight until the end.”

High-ranking cardinal found guilty of financial crimes. The Vatican’s “trial of the century” ended with Cardinal Giovanni Angelo Becciu being found guilty of embezzlement and fraud in the church’s criminal court and sentenced to five and a half years in prison. Eight others in connection with Becciu, who had been considered a candidate to be the next pope, were also found guilty of financial crimes or abuse of office. Prosecutors discovered money transfers as part of a London real estate deal approved by Becciu in 2013 and 2014; the court found that the transactions were embezzlement and ordered the guilty parties to pay the Vatican more than $200 million in restitution. The ruling can be seen as a win for Pope Francis, who was elected in 2013 with a mandate to reform the church.

The FDA is investigating whether elevated levels of lead in some cinnamon applesauces, which affected as many as 125 kids in the US, were the result of “economically motivated adulteration”—aka food fraud.

“So far all of the signals we’re getting lead to an intentional act on the part of someone in the supply chain,” the FDA’s Deputy Commissioner for Human Foods Jim Jones told Politico last Thursday. The investigation is zeroing in on a single manufacturing facility in Ecuador with links to the cinnamon applesauce pouches sold under three brands—Weis, WanaBana, and Schnucks—which were recalled in November.

What is food fraud? It’s when a producer manipulates ingredients in a food product to gain a competitive edge (think: “watering” down olive oil with cheaper vegetable oil). This type of fraud could cost the global food industry up to $40 billion a year, according to some estimates.

And why do it with applesauce? The cinnamon is the key. Lead can be added to spices with a reddish hue to increase weight (making them pricier) or to make the red color more vibrant, food safety experts told the NYT.

Big picture: The FDA does not currently test for lead in food imported to, or made in, the US, which critics say leaves kids who eat these products as guinea pigs.—NF

Hong Kong media tycoon on trial: Imprisoned media mogul Jimmy Lai will go on trial today in a globally significant case that’s considered a test of Hong Kong’s judicial independence following a security crackdown by China in 2020. Lai, who founded the pro-democracy tabloid Apple Daily, has been charged with colluding with foreign forces and sedition, and could face life in prison. One of Lai’s sons has called it a “show trial.”

Blue Origin attempts a return to space. Jeff Bezos’s space company, Blue Origin, will aim to launch its New Shepard rocket in a cargo mission as soon as today. The rocket has been grounded for 14 months after suffering a midlaunch failure in September 2022.

Coming to streaming: Gwyneth vs Terry: The Ski Crash Trial drops today on Max. Paltrow (the titular Gwyneth) was found not at fault in March for a 2016 skiing accident involving optometrist Terry Sanderson. Also, the Leonard Bernstein biopic, Maestro, is coming to Netflix on Wednesday. Bradley Cooper stars as the composer in the film, which is also written and directed by Cooper.

Everything else…

• Today is “Answer the Telephone Like Buddy the Elf Day,” so when you answer the phone, you must immediately ask the caller their favorite color.
• The first day of winter—the shortest day of the year in terms of daylight—arrives on Thursday. Maybe finally we’ll get some snow???
• Here’s a list of all the college football bowl games happening this week.
• Festivus is on Saturday. Decorate that pole and air those grievances.

Stat: Has Harvard lost its luster? Early admission applications to Harvard dropped 17% this year to their lowest levels in four years, the school revealed last week. Meanwhile, Yale’s early applications increased 1.4%, and UPenn reported a more than 6% increase. Applications were due on Nov. 1, over a month before three university presidents, including Harvard’s and UPenn’s, gave widely criticized testimony at a congressional hearing on antisemitism. This is also the first enrollment period since the Supreme Court banned race-based admissions (affirmative action) in higher education.

Quote: “We just suck at putting.”

That harsh criticism comes from 14-year-old Charlie Woods about himself and his father, Tiger, who has made one or two putts during his legendary career. The duo shot 8-under 64 Saturday at the PNC Championship, a team event featuring major champions and their family members. Though Charlie felt like the day could have gone better, Tiger was euphoric to have his kids on the course—not only was he competing with his son, but his daughter, Sam, caddied for him for the first time.

Read: The self-checkout even haters will love. (Wall Street Journal)

Pod rec: Jeff Bezos chats with Lex Fridman.

Wordplay: A brain teaser game that will consume your day, 20 seconds at a time.

Product review: Eggo’s brunch in a jar.

Sky news: An argument for bringing back airships, the trucks of the sky.

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