Writing a Blog: What I’ve Learned

I hereby return from my blog break. This year on my break I contemplated the future of my blog: do I want to continue the blog, or has it run its course? I decided I will continue writing blog posts for now, since people still seem to be reading them, and also because writing posts usually forces me to become better informed about my topics, ultimately benefitting me.

I started this blog ten and a half years ago, only for the purpose of promoting a book about opioid use disorder that I had written, titled “Pain Pill Addiction: Prescription for Hope.”

Against all odds, I was able to get an agent for my book. My agent tried hard to sell my book to publishers, but none were interested in an obscure topic like opioid addiction (in 2010 we were not yet using the term “opioid use disorder”). Eventually, I decided to self-publish.

My book did OK, for a self-published book, selling around 400 copies. I probably sold the majority of those myself, peddling them to independent bookstores to sell on consignment and giving copies to patients. A surprising number sold on Amazon. Then a few years ago, since the book was so out of date, I started sending an electronic copy to anyone who wanted it, for free.

I started the blog only to promote the book, a bit of advice I heard and read from many writers and would-be writers.  I started writing blog posts about opioid use disorder and its treatment with medication-assisted treatment.

The blog did much better than I expected, and I’ve enjoyed writing it more than I thought. I’m still amazed at the number of readers I’ve had over the years, and the variety of readers. I’ve been blessed by attracting the attention of knowledgeable people in this country, with reputations for brilliance. For example, I love every time Dr. Wartenberg writes a comment. He has so much experience and insight.

I’ve had over 1.6 million views of my blog, with over 5600 comments written. My blog traffic peaked a few years ago, when I still had the energy to write a blog each week. Now that I post every few weeks, I get 300-500 views per day. That’s still many more than I expected.

I’ve repeated some blog entries, such as those dealing with a specific topic like drug interactions, or specific drugs like kratom, but for the most part, my blog posts are original. Some posts that I’ve tried to re-cycle from ten years ago had to be re-written because the language has changed – or I have changed. I no longer use the words “addict” or ‘addiction” or at least don’t use them very often, because I’ve become more sensitized to people’s feelings.

Some readers send appalling comments that I won’t approve to appear on my blog, either because they demean people with opioid use disorders or demean people trying to provide care to them. Occasionally I’ll post an offensive comment, to serve as an example of outdated attitudes still held by some people about the nature of substance use disorders and their treatments.

I had one interesting commenter say that I was sinning by having this blog, and that I’d go to hell for it. I’m still not sure what my sin was, aside from dangling a participle or two. Thankfully most commenters are more intelligent and focus on content rather than attacking me as a person.

By far, the most accessed of my blog posts are the ones related to injecting buprenorphine. My site stats tell me that out of the past 408,000 blog views, 151,000 of those views were of my blogs about injecting buprenorphine and complications related to it. I’m not sure what to make of this. It could be a good thing, if people injecting or contemplating injecting buprenorphine are concerned and want to know of possible adverse effects of this practice.

The next most frequently viewed post was about switching from methadone to buprenorphine, at 54,000. The next most popular posts were about overdose with opioids and benzodiazepines, urine drug screening, and getting a commercial drivers license while on buprenorphine.

Often I’ll write a fluffy little post that I regard as a throw away, just something to put on the blog until I get something of substance to post, and I’ll get a big response that I didn’t expect. For example, my post recently about how I got a fever and viral gastroenteritis during COVID and thought I was dying got a lot of responses. Most were in sympathy, acknowledging how jumpy we all are with any sign of illness that could be COVID.

In the blog posts where I complain about difficulties with pharmacies, I get many responses from patients but even more from other medical providers. They tell me their stories of frustration with pharmacy practices and attitudes, and my own frustrations feel validated.

I have intelligent readers who are in treatment for opioid use disorders. They’ve helped me understand more about patients’ feelings, and how they view things. For example, I regarded the reduction of a patient’s take home level for positive urine drug screens as enforcement of state regulations, kind of mechanical and temporary. However, I’ve learned patients take the revocation of take home doses very personally. They take revocation as a slap in the face, like I am telling them I’ve lost faith in them and their recovery.

I don’t write as much about 12-step recovery now as I did ten years ago. Referral to 12-step groups is evidence-based, but most patients aren’t interested in going. I also feel that these 12-step groups have missed opportunities to reach people with opioid use disorder. My patients on medications to treat opioid use disorder aren’t always treated well at meetings.

I know that these groups can work well. In some prior posts, I’ve hinted that I’m in recovery, so today I’ll say it outright – I’ve been blessed with over twenty-two years of recovery mostly through the power of 12-step groups. I’ve gone to two or three thousand meetings over the past few decades. But this form of recovery is not the only way people recover, and some people don’t want to go to such groups.

A few years ago, four of us in recovery founded a Narcotics Anonymous meeting in our little town, with the express purpose of welcoming people in medication-assisted treatment to our NA meeting. We attracted a dozen or so people to come irregularly, but for the most part, only the four founding members regularly attended our meeting. After a few years, COVID hit, and we changed to online meetings for some months. Now, after one member moved away and another had a change in work schedule, we let the meeting close due to lack of interest. I must admit I was relieved.

These days I see how important it is to fact check everything that I write. In these days of misinformation, and dis-information, and outright lies, truth is ever more important. If I write a blog post stating that this or that conclusion is supported by research, I’ll double – check before posting.

Of course, blogs are more than recitations of fact. When I state an opinion, I’ll make it clear that it is only an opinion. I have many of these opinions, and they are subject to change, as new information is revealed. When I read posts from ten years ago, some of them embarrass me a little, because I no longer feel exactly the same. But that’s OK, because – hopefully – it means I’m still capable of change and growth as a person.

Having a blog is a fun way to vent. I try not to be grouchy in my real life, but on the blog…I can spew about my frustrations regarding various work irritations. I can give anonymous voice to my patients who are treated badly by this medical system because they are in medication-assisted treatment. I can call out pharmacists who seem to give my patients a hard time only because they have opioid use disorder.

It’s fun.

So for now, I’m going to keep my blog going.

26 responses to this post.

  1. Posted by Jon-eric Baillie, M.D. on October 12, 2020 at 6:40 pm

    Thank you for continuing your blog

    Reply

  2. Dr. Burson your blog is authentic and completely unique. It’s the only blog (out of many) I’m subscribed to, that I am thrilled to see a new entry for and always read.

    Reply

  3. Posted by Jane Daniels on October 12, 2020 at 7:22 pm

    Hello Dr Burson,
    I am glad to hear that you are continuing your blog, even if only intermittently. I came across it about two years ago when researching information about opioid use disorder. I am a staff research coordinator at a large university, we have worked on two projects related to opioid use with families and children. Your blog has been very helpful as it is factually informative and trustworthy, and you are able to explain things in a way that isn’t always clear in research papers. But I have kept reading because it has also been ‘attitudinally’ informative for me personally. It has helped me find the thoughts and words to trust and express my feelings and limited knowledge about opioid use disorder, and how addiction needs to be understood and approached. I appreciate your grumpiness because it allows me to be a little bit angry. I appreciate your droll humor as well because we all learn better when there isn’t judgment and because often the topic is so serious and sad.
    The son of a family friend died of an overdose over the weekend. I didn’t know the son. I had recommended your blog to his mother, my friend. I don’t know if the overdose was opiates, but that was drug with which he struggled. Because of your blog and other readings, I know that he struggled. I know that as a society we sometimes do really awful things to people suffering from addiction, and, that we don’t do nearly enough. So he might have struggled needlessly. Because of your blog I know a lot more about brain chemistry. I hoped that he would be allowed to stay on methadone, instead of having to detox ‘off everything’ at rehab. I know there’s a chance he didn’t mean to die. Because of your blog I have only empathy, and enduring sorrow, for his parents.
    My apologies for the sad post, but thank you for the blog.
    Hope you and yours are well. Jane

    Reply

  4. Posted by Jerry R McKee on October 12, 2020 at 7:36 pm

    Yeah… rumor has it that the hottest parts of Hell are reserved for those who butcher the King’s English while serving a great educational purpose around substance use disorder. Keep on bloggin’

    Reply

  5. Posted by Nathan Czerniak on October 12, 2020 at 8:01 pm

    I read your blogs, and so many of the people in my MAT Advocacy group so too!! I have learned a ton just from your blog alone. It’s great to have a doctor’s perspective!! I hope you don’t stop because you don’t think it’s worth it or making a difference, because it is! Thank you!
    By the way, do you have an email address or some way I can ask you a question privately?

    Reply

  6. I’m always interested to read your blog – thanks!

    Reply

  7. Posted by Mary Anne Hughes on October 12, 2020 at 11:07 pm

    Yay you! I love your blog and share it with my colleagues, patients and their families. It is authentic, heartfelt and humorous. And the fact that it is backed up by your vast experience and latest research, gives me the confidence to share it. And I know for sure it has made me a more thoughtful and I hope, a better provider. Thanks, Jana, from your following near, far, and yet to be discovered!
    Warmest Regards, Mary Anne Hughes NP

    Reply

  8. Posted by Sparky on October 13, 2020 at 2:27 am

    Love your bog and your opinions,keep up the fine work,hopefully your knowledge and kindness will inspire other drs to treat addicts on opioid use disorder medications the same way you treat your patients,so wish all the drs were like yourself but sadly they are not,keep the blog going and going and going and going(like energizer bunny) lololololol

    Reply

  9. Posted by Spencer Clark on October 13, 2020 at 12:00 pm

    Jana:

    Thank you so very much for continuing this valuable contribution to the field.

    Your clarity, passion, and independence of thought are unique, particularly when coupled with your level of empathy, self-reflection, humility, and courage to speak on controversial topics with a quiet and humane voice.

    It is a privilege to read and appreciate your blogs that are so important in these challenging times.

    My best to you and family,

    Spencer

    Spencer Clark, MSW, LMSW, ACSW

    Reply

  10. Posted by Patrick R Grissom on October 13, 2020 at 2:07 pm

    Hello! I am a avid reader of all your blogs and it is a great way for to update my thoughts and treatment of our patients at the clinic I work. Your information is invaluable! As a program director in Texas, this helps me see how other practitioners in the world are approaching MAT and the stigma attached. The outreach and education I can give to the naysayers. I am so glad you decided to stay, I look forward to what you write every week. Blessings

    Reply

  11. Thank you all for your kind comments about me & my blog!

    Reply

  12. Posted by Alan Wartenberg MD on October 13, 2020 at 6:20 pm

    Was very pleased to see your blog re-entry. I have been a faithful reader since Zac clued me into it, and I have enjoyed every post, and particularly the replies. I am toying with the idea of writing my own. The poster who spoke of the son of a friend who OD’d after being “detoxed” from everything is hit me particularly hard. The day will come when that kind of treatment is considered not only medical malpractice but involuntary manslaughter.

    Reply

    • Posted by Mark Wulff on October 15, 2020 at 7:40 am

      IMO that day can’t come soon enough Alan – “when that kind of treatment is considered not only medical malpractice but involuntary manslaughter”.

      I am quoting from an article in The Fix called ” The Truth About Suboxone” (which also includes Kristen Johnston’s experience with Suboxone author ” Guts – The Endless Follies and Tiny Triumphs of a Giant Disaster”) :

      “Research repeatedly finds that when access to maintenance is reduced or eliminated, deaths from drug overdose rise, as do rates of infection with HIV, hepatitis C and other blood-borne diseases.

      In fact, patients on maintenance treatment have a death rate three to four times lower than those who leave it.

      It is clear that maintenance saves lives.

      Nonetheless abstinence proponents like Dr. Drew (Celebrity Rehab With Dr. Drew) and addict authors like Lyons (Joshua Lyon author ‘Jagged Little Pill Head’) not only portray these medications as inferior, but implicitly or explicitly push addicts to stop taking them, even when the meds are working.

      That can be deadly—as it apparently was for two of the patients Dr. Drew detoxed from maintenance, Mike Starr, the former bassist in Alice in Chains, and film and TV actor Jeff Conaway.

      Both victims of Celebrity Rehab With Dr. Drew died of overdose or related issues, the risk of which is very far reduced by maintenance treatment”.

      Reply

      • Yes Mark, every time I listen to “Man in a Box” I think about Mike Starr and what a shame it was that he didn’t get the gold standard of treatment. Who knows how many people, famous and not famous, have died because they weren’t told about medication to treatment OUD, or were told to stop medications to treat OUD.

    • Yes! Yes! You need to write a blog.
      Your knowledge/experience/wisdom should be recorded and a blog would be a very modern way to do that and reach so many people.
      And yes…so sad when patients are taken off evidence-based treatments and then die. It is malpractice in the very least.

      Reply

  13. Posted by Christian Gilbert, MD on October 13, 2020 at 6:33 pm

    I am glad you are back, I do like to read your comments and have a like mind on all things MAT. I am new to the field with only 4 years experience, and only one year experience as the Medical Director at a large OTP in Wilmington, where we treat close to 1400 people/day on methadone. I have so much to learn. One recent question was asked and I would love to hear your take on it. When is methadone no longer effective for treating OUD, is there a dose above which nothing further is gained. We are getting into dose ranges of 250 mg and higher, sometime with the patients still using large amounts. of fentanyl. When do you say that out patient treatment is just not working? Perhaps naively I thought you simply needed to raise their dose to whatever it took. I am still seeing about 65% fentanyl positive urine screens despite initiating an aggressive dosing strategy one year ago when I took over. Thank you so much for all you do.

    Reply

    • I’m going to answer with a very firm and frustrating, “It depends.”
      Is the patient still using because she’s still craving opioids? because she has withdrawal symptoms? Because she’s “addicted” to the act of injecting? Because she’s still hanging out with people who use fentanyl in front of her? COuld the patient be a fast metabolizer and need a split dose?
      For each situation you must sit down with the patient and get information to decide why that patient is still using. Depending on what the patient says, the solutions will be different. I think you will find that continued withdrawal doesn’t always drive continued opioid use. If it did, as you say, increasing the dose would be the answer for every patient.
      I hope this nebulous answer gives some ideas.

      Reply

  14. Posted by Johnna Whelihan on October 13, 2020 at 8:51 pm

    HI Dr B, thanks for continuing your blog, I came upon it totally accidentally when researching how to wean off Sub and was touched to read how caring you are with your patients. , most only care about making money . I have been encouraged by all the success stories you have shared .Thank so much!

    Reply

  15. Posted by LynnAPRN on October 13, 2020 at 10:15 pm

    I am a nurse practitioner, and I really enjoy your blog. I wish there was an exclusive support group (virtual — now with covid-19) for healthcare providers in recovery. This is a whole topic on it’s own (would love to see you do something on this!). As someone in recovery, I know providers are reluctant to seek treatment for fear of the punishment from the powers at the boards of medicine and nursing. Thank you for doing what you do. I now work in clinical research, and am almost two years free off the pain medication that could have killed me (I became dependent/addicted due to an injury sustained as an ICU nurse, never used IV drugs). There is still a LONG way to go to change attitudes of people towards treatment and recovery, but my hope is that with caring providers like you, we will get there!

    Reply

    • Some states do have these groups.
      Our state has Caduceus groups for physicians and physician extenders, and I know nurses have a few meetings scattered across the state.
      To find these meetings, you might contact your state’s physician health program and ask for a person to contact for meeting time and location in your state. I used to go to such a meeting in a large city near me and sometimes we had 45-50 people attending. It was very helpful for me to see other very good doctors had also developed substance use disorders and were in recovery and doing well.

      Reply

  16. Posted by tracihudson on October 13, 2020 at 10:55 pm

    Thank you for continuing! Your blog posts have given me invaluable information especially when I was first researching MAT concerning my daughter and have continued to be. Also, knowing the frustrations you encounter as a provider and concerning some clinic practices have given us an understanding of the difficulties your being faced with as well, while trying to navigate this disconnected road. I share your info with my daughter and recommend your blog to anyone searching for help. Thank you for fighting for MAT!

    Reply

  17. Posted by Charles E. on October 14, 2020 at 2:51 pm

    Thank you, Dr. Burson. I enjoy your blogs and hearing things from the point of view of the provider. I am on Sublocade, and although I didn’t like it at first, I think it’s the best thing that’s happened to me since I relapsed on pain pills in 2007 after 18 years and 10 months of clean time. Sublocade has allowed me to not center my life around the dosing, and to just live normally, or as much as one can during a pandemic. I was on methadone very briefly, and I am glad that that didn’t last, because I understand that it is a difficult detox off of it. And Kratom, I have had some experience with that as well, but I didn’t know you had written about it. Now look what you made me do. I have to search your articles for ones about Kratom. If you would be so kind, could you give me some links?

    Again, thank you for your work and your writing.

    Reply

  18. Posted by Ronny Freedom on October 19, 2020 at 1:00 pm

    Still reading after about 8 years. Thank you for sharing your insightful experiences. Keep up the good work!

    Reply

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