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The Vivienne's cause of death has been revealed two months after they died suddenly aged 32.
The RuPaul's Drag Race UK star's manager, Simon Jones, confirmed in a statement that the drag artist - born James Lee Williams in Colwyn Bay, Wales - died "from the effects of ketamine use causing a cardiac arrest".
"James's family and I feel it is important to say how James tragically died. It was from the effects of ketamine use causing a cardiac arrest," he shared.
Jones noted there will be a formal inquest into The Vivienne's death in June.
"I hope that by us releasing this information we can raise awareness about the dangers of ongoing ketamine usage and what it can do to your body," he continued. "Ketamine usage is on the rise, particularly amongst young people, and I don't think the full dangers of the drug are being discussed."
The performer's sister, Chanel Williams, added in a statement to Attitude: "We continue to be completely devastated by James's sudden death.
"Ketamine is an extremely dangerous drug that is becoming more and more prevalent in the UK. If we can help raise awareness of the dangers of this drug, and help people who may be dealing with ketamine addiction, then something positive will come from this complete tragedy."
In 2023, Friends star Matthew Perry also died from a ketamine overdose.