I am on it right now, doctor proscribed though. Currently taking 30mg twice a day and the difference with me has been profound; both with the side effects and with the acne. To start, the negatives are pretty harsh. Bloody noses every few days, my lips LOOK and FEEL like someone hit them with a rasp, and it makes contact wearing a bitch too (a bitch but still doable). As far as the good goes it's amazing. I HAD systic nodular acne on my back and scars all over my lower back from years of it. Not only has the accutane cleared up the acne but also the scars! The biggest difference with me is how oily my skin was. It was so bad before accutane that 20 minutes after I washed my face I had a sheen of oil. Hair, back, all of it was oily. Now I might be super self-critical as my fiance says it wasn't that bad but I really think it was. Hell, my skin was so oily that you could tell which side of the bed I was sleeping on by the tint of the sheets! F'in gross I know. All that shit is gone though now. I've been on accutane since the first week of may. Also, I have to get blood tests every month prior to each prescription and my cholesterol is ALWAYS jacked.
Big picture, if you have acne that in one way or another has screwed up your life, then accutane is the shit. For little breakouts here and there I don't think it would be worth it... It has definitely made my cycle a breeze though, 500mg test enan a week and not a pimple to show for it!