Jonathan Medland’s voice crackles with a mix of anger and emotion when he discusses the tragic loss of his son, Jon, who took his own life at the young age of 22. “He was an exuberant, engaging, funny, and truly incredible young man. Everyone he encountered had nothing but praise for him. He had a bright future ahead of him,” says Jonathan, a retired driving instructor from Barnstaple in Devon. “But that drug destroyed his brain.”
The drug in question is isotretinoin, commonly known as Roaccutane. It was initially approved in the UK in 1983 to treat severe acne and has since been prescribed to hundreds of thousands of patients. Jon, a medical student, was prescribed the medication for back acne in late 2003. Shortly after starting the treatment, he was found dead in his university accommodation at Manchester University. Until this day, 20 years later, Jonathan firmly believes that the drug was responsible for his son’s tragic fate.
Isotretinoin is widely used, with approximately 40,000 NHS prescriptions issued each year, primarily by dermatologists. While it can be highly effective in treating acne, its reputation has been tarnished by suggestions that it may have driven nearly 100, and possibly more, young men and women in the UK to take their own lives. Many of those who died were teenagers who, like Jon, had no history of mental health issues.
Bereaved parents and advocates are now demanding action from NHS drug authorities to address the risk of further suicides among young adults taking the drug. In response to a rise in reports of adverse reactions, the Medicines and Healthcare products Regulatory Authority (MHRA), which oversees the safety and usage of all medicines in the UK, initiated a comprehensive review of isotretinoin’s potential to cause harm.
Since its approval four decades ago, isotretinoin has generated nearly 8,000 reports of adverse reactions, ranging from severe birth defects and erectile dysfunction to vision loss and nervous system damage. Roughly one in four complaints are related to severe psychiatric reactions, including anxiety, depression, personality changes, and suicidal thoughts.
According to the Yellow Card system, there have been 88 recorded cases where isotretinoin is suspected to have contributed to suicides among young people. However, campaigners believe that the actual number is much higher due to substantial under-reporting of adverse drug reactions.
While the MHRA’s review sought to address these concerns, its decision, published in April, fell short of implementing consent forms or even a partial ban. Instead, the MHRA ruled that doctors could continue prescribing isotretinoin as the benefits for young adults suffering from severe acne outweigh the risks. The MHRA’s chief safety officer, Alison Cave, stated that no medicine is entirely risk-free and that, on balance, the benefits of isotretinoin justify its use in severe acne cases.
Although the review did not recommend consent forms, it did call for new measures to ensure responsible prescribing practices. For example, starting in the coming months, individuals under the age of 18 will only receive isotretinoin if two medical professionals agree that it is necessary. The report also emphasized the need for improved communication and monitoring of patients’ psychiatric and sexual health.
Isotretinoin works by reducing the production of sebum, the oily substance that can contribute to acne, by shrinking the sebaceous glands. While it has been a lifesaver for some patients, others have suffered severe side effects and mental health issues. Striking the right balance between the benefits and risks of isotretinoin remains a challenge, but the MHRA’s review represents a step towards greater awareness and vigilance in administering this medication.
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