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Matthew Perry‘s cause of death has been confirmed two months after he passed away.

According to the Los Angeles County Medical Examiner’s office, Perry died from “the acute effects of ketamine.” A toxicology report released on Friday, December 15, also listed drowning, coronary artery disease and the effects of buprenorphine (which is used to treat opioid use) as contributing factors. The actor’s death was ruled an accident.

Perry died at his Los Angeles home at age 54 on October 28. Authorities reportedly responded to a call of someone going into cardiac arrest, and Perry was found unresponsive in his hot tub. There were no signs of foul play at the scene.

His cause of death was “deferred” following his initial autopsy, the Los Angeles County Medical Examiner said on October 30. The results were determined to be inconclusive pending a toxicology report, and a further investigation into the cause of Perry’s death was requested.

Related: Matthew Perry’s Ups and Downs Through the Years

Matthew Perry never shied away from opening up about his struggles after rising to stardom for his role as Chandler Bing in Friends. “When [fame] happens, it’s kind of like Disneyland for a while. For me it lasted about eight months, this feeling of ‘I’ve made it, I’m thrilled, there’s no problem in the world.’ […]

Perry was best known for his work on NBC sitcom Friends from 1994 to 2004, on which he portrayed the sarcastic Chandler Bing, one of the original six leads. He also starred in films such as The Whole Nine Yards, Fools Rush In and 17 Again and was nominated for five Emmys for his work on TV shows Friends, The West Wing, The Ron Clark Story and Friends: The Reunion. The actor became a bestselling author when he published his 2022 memoir, Friends, Lovers & The Big Terrible Thing.

While he was known for making people laugh, Perry struggled with his mental health and addictions to drugs and alcohol behind the scenes.

During Friends: The Reunion, which premiered in April 2021 on Max, Perry recalled how anxious he felt while filming. “I felt like I was gonna die if they didn’t laugh. It’s not healthy for sure, but I would sometimes say a line and they wouldn’t laugh, and I would sweat and go into convulsions,” Perry said. “If I didn’t get the laugh I was supposed to get, I would freak out. I felt like that every single night.”

He remained close with his Friends costars — Jennifer Aniston, Courteney Cox, Lisa Kudrow, Matt LeBlanc and David Schwimmer — who said in a joint statement that they “were utterly devastated by the loss” of their pal.  “We were more than just cast mates. We are a family,” the group said to Us Weekly on October 30. “There is so much to say, but right now we’re going to take a moment to grieve and process this unfathomable loss.”

Friends cocreators Marta Kauffman and David Crane and their fellow executive producer Kevin S. Bright said they were “shocked and deeply, deeply saddened” by Perry’s sudden death.

“He was a brilliant talent. It’s a cliche to say that an actor makes a role their own, but in Matthew’s case, there are no truer words. From the day we first heard him embody the role of Chandler Bing, there was no one else for us,” the trio shared in a statement to Us Weekly on October 29. “We will always cherish the joy, the light, the blinding intelligence he brought to every moment — not just to his work, but in life as well. He was always the funniest person in the room. More than that, he was the sweetest, with a giving and selfless heart.”

Prior to his death, Perry wrote about how he hoped to be remembered for helping people through their darkest times.

“I would like to be remembered as somebody who lived well, loved well, was a seeker,” Perry said on the “Q With Tom Power” podcast in 2022. “And his paramount thing is that he wants to help people. That’s what I want.”

He added: “The best thing about me, bar none, is that if somebody comes to me and says, ‘I can’t stop drinking, can you help me?’ I can say ‘yes’ and follow up and do it. When I die, I don’t want Friends to be the first thing that’s mentioned. I want that to be the first thing that’s mentioned. And I’m gonna live the rest of my life proving that.”

Related: Matthew Perry and Courteney Cox Over the Years: ‘Friends’ and Beyond

Matthew Perry and Courteney Cox’s chemistry as Chandler Bing and Monica Geller on Friends was so strong that many fans wondered if the actors had an offscreen romantic connection. Despite falling in love and getting married on the NBC sitcom, Perry and Cox’s real-world relationship was always platonic. In fact, Perry and Cox gave fans […]

That’s exactly how Hank Azaria, Perry’s longtime pal and a Friends guest star, remembered him in a tribute following his passing.

“Matthew and I became really good friends and we were really more like brothers for a long time,” Azaria said in a video shared via Instagram on October 29. “We drank a lot together, we laughed a lot together, we were there for each other in the early days of our career.”

Azaria eventually turned to Perry when he decided to battle his alcoholism. “I’m a sober guy for 17 years, and I wanna say that, the night I went into AA [Alcoholics Anonymous], Matthew brought me in,” the actor added. “The whole first year I was sober, we went to meetings together. He was so caring and giving. He totally helped me get sober.”

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