The dose of buprenorphine is then adjusted until symptoms improve, and individuals remain on a maintenance dose of 8–16 mg.: 99–100   Because withdrawal is uncomfortable and a deterrent for many patients, many have begun to call for different means of treatment initiation. Some providers have begun to use the Bernese method, also known as microdosing, in which very small doses of buprenorphine are given while patients are still using street opioids, and without precipitating withdrawal, with medicine levels slowly titrated upward. Buprenorphine versus methadone
Both buprenorphine and methadone are medications used for detoxification and opioid replacement therapy, and appear to have similar effectiveness based on limited data. Both are safe for pregnant women with opioid use disorder,: 101  although preliminary evidence suggests that methadone is more likely to cause neonatal abstinence syndrome. In the US and European Union, only designated clinics can prescribe methadone for opioid use disorder, requiring patients to travel to the clinic daily. If patients are drug free for a period they may be permitted to receive "take home doses," reducing their visits to as little as once a week. Alternatively, up to a months supply of buprenorphine has been able to be prescribed by clinicians in the US or Europe who have completed a basic training (8–24 hours in the US) and received a waiver/licence allowing prescription of the medicine.
Experimentally, local anaesthetic injections and tying of the arteries is reported to trigger the development of tissue changes similar to NS in lab rats. Factors which are thought to cause this ischemia are listed below, however sometimes there is no evident predisposing factor or initiating event. Trauma e.g. during intubation, or surgical procedures
Local anesthetic injection
Smoking
Alcohol
Diabetes mellitus
Vascular disease, (e.g. arteriosclerosis)
Pressure from a dental prosthesis
Allergy
Bulimia
Infection
Ionizing radiation

Diagnosis
Differentiation between this and SCC would be based on a history of recent trauma or dental treatment in the area. Immunohistochemistry may aid the diagnosis. If the lesion is NS, there will be focal to absent immunoreactivity for p53, low immunoreactivity for MIB1 (Ki-67), and the presence of 4A4/p63- and calponin-positive myoepithelial cells. Treatment
No surgery is required. Prognosis
Healing is prolonged, and usually takes 6–10 weeks. The ulcer heals by secondary intention. Epidemiology
The condition is rare. The typical age range of those affected by the condition is about 23–66 years of age. It usually occurs in smokers. The male to female ratio has been reported as 1.95:1, and 2.31:1. History
NS was first reported by Abrams et al. in 1973. Notes
References


== External links ==