The Director’s Cut

A while ago I wrote a piece for GUM (Glasgow University Magazine) as part of a collaborative effort between themselves and The GIST. Due to the word count limitation, I had to cut the article down to 800 words (feel free to read it; pages 34-35). There was originally a plan to publish the longer article (which I like a little more) on The GIST’s website but As I’ve handed off most of my responsibilities to a new generation of GISTers I suspect that this article will fall to the bottom of their to-do list and I’ve decided to post the full article here. I hope you enjoy it.

Dying For Clarity

How do you begin to respond to an emotional story of loss and tragedy when you think that the methods used to tell the story are wrong? Not only wrong, but an affront to science? Couple this with the fact that the tragic story is conveyed via a heart-felt documentary told by a grieving father and you have a delicate situation on your hands. Essentially, arguing against this story’s conclusions will make you out to be a heartless monster who wilfully ignores the plight of others to focus on “mere” facts. None of this, however, changes the point that the methods used are wrong (or at least inappropriate for this context). Being part of a growing number of people that harp on about badly communicated science at every chance they get, I must say something.

Roaccutane - Image credits: Jpogi e André Teixeira Lima via wikicommons

Roaccutane – Image credits: Jpogi e André Teixeira Lima via wikicommons

In November 2012 I sat down to watch a documentary on BBC three called Dying for clear skin. The show focused on the use of the drug Roaccutane as a treatment for acne. Many readers I’m sure will be familiar with this drug and maybe even the documentary itself (if not, it’s available on YouTube). Very quickly the show centred on the more serious potential side-effects of the medication and told a heart-wrenching story of suicide that could perhaps, have been triggered by taking this drug. With the BBC being an institution desperate to provide balance on all its topics I had suspected that this emotional-rollercoaster would be countered at some stage by a good scientific argument to provide evidence for or against the banning of this drug, which was ultimately the point of the show. Sadly however, I was disappointed. Instead, the show relied almost exclusively on personal accounts to paint a picture that didn’t accurately reflect the whole story. By cherry-picking the personal accounts of a few they told an inherently biased story and although I suspect that this approach made for excellent television, it effectively removed the science from what was a valid scientific argument.

The personal accounts used to tell the story here were touching and at some points wholly concerning. But it’s important not to get drawn into these stories without further checking the facts (something I suspect most viewers wouldn’t do). When I checked some of the sources I was further disappointed. One of the people interviewed in the documentary, a 22 year old man named Stefan Lay, told his tale of how Roaccutane led to feelings of depression and sexual dysfunction. He appeared as an intelligent young man with an honest story to tell. However when I later found his YouTube channel I quickly realised that he is a person who not only hates Roaccutane but seemingly all prescription drugs. His YouTube channel is called FireYourDoctor, where he tries to discourage people from taking any medication whatsoever. With the dawning of this fact I began to worry about this person’s motives and I can’t help but question his inclusion in the documentary. The makers and presenter of the documentary found him by searching online and selected him on the basis of his YouTube videos. Videos where he expresses views like this:

But I do believe there is a cause. Like, people don’t get cancer for no reason. I don’t think so anyway. I think they’ve got to be a bit run down, or their body has been playing up and they’ve not really noticed the signs of that and they’re not taking their health seriously or they’re not eating well enough… I don’t think the cancer just pops out from nowhere.[1]

Oh dear. Undeterred, the film-makers interviewed him and used the footage where he stated that Roaccutane had caused his inability to have sex and caused him to “feel dead inside”. Yet in his own review of the show, posted on his channel, he stated that these side-effects weren’t as bad as reported and that in fact, he was still able to have sex.[2] I suspect that he was used as an interviewee because he was young, photogenic and told a story that suited the film makers (perhaps after some editing or careful scene selection).

After a few more personal accounts the documentary finally focuses on the evidence that is available in an attempt to link Roaccutane to depression or suicidal tendencies. In the 2 minutes (out of 57) dedicated to this, the facts were glossed over as irrelevant (presumably as they didn’t agree with the points being made) and fobbed off as incomplete. Sadly the film missed its chance to have a serious debate about the drug by ignoring the science. The fact is this. Out of half a million people who have been prescribed Roaccutane worldwide, reports of nine people committing suicide whilst taking the drug were made to the drug’s manufacturer. To add some context to this, that is 88% lower than the UK average (17 per 100,000 population[3]). Not only this, but the film didn’t properly explain to its audience that these suicides could have been caused by any number of different reasons. You’ll hear it time and time again; correlation does not equal causation.

Roaccutane description

What is very disheartening though is that I think there is a serious debate to be had here. Roaccutane usage is surprisingly common. The drug is not without its (proven) side-effects,[4] the mechanism of action is not fully understood and, worryingly, it appears that this “last option” treatment is sometimes used earlier than needs be.[5] Yet all these points were forgotten in favour of the emotionally-manipulative story of an unproven link to suicide made through the use of questionable and unscientific sources. The calls that came from the makers of this documentary (and some viewers) to ban Roaccutane were reactionary and misinformed. This sort of knee-jerk reaction to an emotional story is unsurprising but the fact that it’s the aim of the documentary is discouraging to say the least. This should have been a scientific argument. Scientific evidence is how we decide if drugs get their licence. Shouldn’t the story have followed the narrative that Roaccutane usage is on the increase, and GPs and dermatologists need a reminder that they are prescribing an incredibly potent drug to potentially vulnerable users? Maybe a call to monitor side-effects much more closely would have been sensible. Perhaps tackling a blasé attitude to the drug would have been much more productive. If nothing else, a call for more studies and more information would have been the logical thing to do. However that’s not what BBC three thinks its viewers want to see and instead they peddled a heart-felt but irrelevant story to an audience it clearly doesn’t respect enough. Not everybody tunes into the BBC to watch ‘Snog, Marry, Avoid?’. Come on BBC, you can do better.





[5] and

2C what people are talking about

2CB, Tripstasy, Nexus, Rusko, Bs

The chemical structure of 2CB. Image Credits: Craig McInnes

I talk a lot about drugs. I don’t take drugs, but Jesus Christ, do I talk a lot about them. It seems the moment I tell people I’m a chemist, the conversation inevitably goes one of two ways; one is talking about drugs. Typically I smile and zone out, I’m just not that interested in hearing about the time someone chewed a hole in their cheek or why their jaw hurts. However, recently I sat, captivated, and listened to what this fella was saying. He spoke about a “new” drug that he’d taken. He spoke about 2CB (pictured on the right).

For a guy that seems to do a lot of questionable things, the thing that surprised me most, was how much he knew about what he was taking. How much everyone seemed to know, actually. Upon meeting this guy for the first time, you could be forgiven for writing him off as a stoner, but this guy knew the dose he was meant to take to get one type of effect, how that effect would be completely different if he took a different dose, what would happen if he took it with MDMA and even when to take it to get the most out of that particular trip. He knew how to take it (different methods gave different effects apparently), what would be the first warning signs of it going wrong and – apparently – what to do to come back down “properly” so that he could go to work the next week and not feel too bad. Fucking hell! He knew more about this than your average pharmacist. I’ve learned over the past few years that people tend to know a little about what they’re taking but this took the biscuit. Perhaps this is just my first real encounter with a hardened drug user but over the course of the next few weeks it would turn out that quite a few people out there knew about 2CB and it seemed that people are quite dangerous with too little knowledge: It only took about 6 weeks before I was having a similar conversation with someone else but this time focused on his mate who was in a chemically-induced coma to prevent brain-swelling from killing him after taking too much of the stuff. (Though sadly this seemed amusing to the second guy.)

What is 2CB and why should I even care?

2CB is a part of the 2C family of psychedelics which were originally synthesised and investigated by Alexander Shulgin – a medicinal chemist and, as it turns out, the ‘father of MDMA’ (ecstasy). Shulgin spent much of his time investigating phenylethylamines (the 2C family) and tryptamines (a related family) and it appears that he tested, on himself, all (or at least most) of the psychoactive drugs that he made (was this normal in the 70s?). He even published two books on his experiences with these and related substances. Somebody has gone to the trouble of constructing a table with all of the 2C family members and placed it on Wikipedia and if you’re interested it would seem a good place to start to at least familiarise yourself with the structures and names. I suspect that this will only be of interest to people with a science background though.

side-by-side comparison of ecstasy and acid

See if you can spot the similarity between these two compounds. Image Credit: Craig McInnes

There’s a plethora of reasons for why you should care (which I started writing out but subsequently deleted) but one seems to trump them all; knowledge is power. Arm yourself with an understanding of what’s going on around you and you’ll be better placed to make relevant decisions about how to deal with certain situations…make of that what you will.

So you know what 2CB is, chemically speaking at least, and it only seems right to explain what it is in terms of its effect (please note that this is anecdotal and I only have two sources of information). At low doses, 2CB is a lot like ecstasy. It makes you feel high in a similar way; things are great to touch, music is more meaningful and intense, colours seem more vivid, etcetera, etcetera. I actually found a fairly well written first-hand account in The Tab though I have no idea who this person is or even if they genuinely took 2CB (I guess that’s a wider point, how does anybody know what they’re taking?) and it seems to be describing a low dose trip. My sources tell me that 2CB’s uniqueness comes from higher doses. Above a certain point (I don’t want to dish out hard numbers) the trip goes from an E-like high, to something resembling LSD, with hallucinations being common. When you consider the structures of both E and LSD (shown above), then compare them to 2CB (the first picture), the chemical reasoning seems sound as to why this might happen. I’ve even taken the time to crudely draw out what different sections of LSD have in common with these compounds (shown below).

LSD subsections

structures seen elsewhere in illegal substances are seen within LSD. Image Credit: Craig McInnes

Getting back to my earlier conversation with the first fella, I had one question for him, “Do you get flashbacks with this?” (The BIG scary thing that you get with LSD.) Needless to say he didn’t know, I guess it’s hardly surprising to find out that he wasn’t concerned with the long-term effects. A red flag popped up when I tried to find an answer to this myself. For all that people talk about how 2CB is “better” or “smoother” or just generally a milder trip (all very short-term concerns) it seems that nobody really knows what the long-term effects are. There have been some pharmacological studies concerning the breakdown products of 2CB but nothing following up on what happened, say, 20 years down the line. If I might venture a guess I’d say that it’s not out of the realms of possibility but upon further reading it appears that nobody really knows what actually causes flashbacks in the first place, so who knows? (I had originally thought it was a lipophilicity issue but it appears that this might not be the case.)

So depending on how it’s taken and in what quantity, the high goes from ‘loved up’ to ‘wow, dude, I can see sounds’.

Anything else I should know?

Probably. 2CB almost certainly works by mimicking serotonin (active on 5-HT receptors, a helical trans-membrane receptor, also known as GPCRs), which makes it work in a fashion similar to ecstasy. The long-term effects of this drug are fairly well known and if 2CB functions in the same way then potentially some of those side effects could happen here too (changes in brain structure, lowering of serotonin transporter proteins, depression and decreased memory function to name but a few possible outcomes).

a 7-helix transmembrane receptor

This is what a GCPR looks like. Image Credits: By Bensaccount at en.wikipedia [Public domain], from Wikimedia Commons

When chatting to this fella I reminded him that legal highs could be just as dangerous as illegal ones and that just because nobody knows of side effects yet, doesn’t mean that there aren’t any. (By the way, 2CB is a class A, restricted drug.) The same rings true for 2CB, just because nobody knows the long-term effects of the substance doesn’t mean that there aren’t any and that seems to be a big problem with any new compound as it ‘hits the market’. (cf. the chemically-induced coma and the phrase, ‘too much of anything is a bad thing’.)

Once all the dust had settled and people were out of comas, the conversation arose one last time (or at least, one last interesting time). These guys continue to take 2CB and it appears its use is on the rise. It seems that we’re only going to hear more and more about this little compound and it seems to be a buyer’s market. Despite the fact that it has been described as the single most painful recreational drug to snort, they continue to do it. They snort it up, drop a pill, burn it and breathe it in, or do whatever they can and in whatever direction is the most effective, just to get high.

I still feel it’s important to know what’s going on around you and crucial to know what might happen if someone were to take it. It’s probably even pretty important to talk openly about these things. I am, however, left with one last question: How bad does it have to get and how empty or unfulfilling does your life have to be before the only way to really have fun is to escape from reality into a line of powder? For today though, I reckon that’s a question which is a little too depressing to ask. Perhaps we’ll save that one for another day.

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