: 84–5   In France, buprenorphine prescription for opioid use disorder has been permitted without any special training or restrictions since 1995, resulting in treatment of approximately ten times more patients per year with buprenorphine than with methadone in the following decade. In 2021, seeking to address record levels of opioid overdose, the United States also removed the requirement for a special waiver for prescribing physicians. Whether this change will be sufficient to impact prescription is unclear, since even before the change as many as half of physicians with a waiver permitting them to prescribe buprenorphine did not do so, and one third of non-waivered physicians reported that nothing would induce them to prescripe buprenorphine for opioid use disorder. Chronic pain
A transdermal patch is available for the treatment of chronic pain. These patches are not indicated for use in acute pain, pain that is expected to last only for a short period of time, or pain after surgery, nor are they recommended for opioid addiction. Potency
With respect to equianalgesic dosing, when used sublingually, the potency of buprenorphine is about 40 to 70 times that of morphine. When used as a transdermal patch, the potency of buprenorphine may be 100 to 115 times that of morphine. Veterinary uses
Veterinarians frequently administer buprenorphine for perioperative pain, particularly in cats, where its effects are similar to morphine. The drugs legal status and lower potential for human abuse makes it an attractive alternative to other opioids.
There are by five characteristic features:
colonisation of endothelial cells by acid-fast bacilli
endothelial proliferation and marked thickening of vessel walls to the point of obliteration
angiogenesis
vascular ectasia
thrombosis of the superficial and mid-dermal blood vesselsThe likely pathogenesis is endothelial cell injury due to colonization/invasion followed by proliferation, angiogensis, thrombosis and vessel ectasia. Treatment
Lucios phenomenon is treated by anti-leprosy therapy (dapsone, rifampin, and clofazimine), optimal wound care, and treatment for bacteremia including antibiotics. In severe cases exchange transfusion may be helpful. == References ==