Background-Opioid-addicted patients undergoing detoxification provide a unique opportunity to assess the effects of chronic opioid receptor stimulation on the sympathetic nervous system. We tested the hypothesis that chronic oral methadone intake decreases resting efferent sympathetic nerve activity to muscle (MSA). Furthermore, we assessed whether this effect is reversed by -opioid receptor blockade during antagonist-supported detoxification under general anesthesia. Methods and Results-Fifteen young patients (30Ϯ1 years old, meanϮSEM) with a long history of mono-opioid addiction and under oral methadone substitution therapy (65Ϯ10 mg/d for 21Ϯ6 months) were selected. Peroneal MSA (microneurography) and catecholamine plasma concentrations (high-performance liquid chromatography) were assessed in the awake state and compared with those of age-matched healthy control subjects. The effects of -opioid receptor blockade by naloxone (12.4 mg IV) were determined during propofol anesthesia. Compared with healthy volunteers, resting MSA (4Ϯ2 versus 22Ϯ2 bursts/min, PϽ0.0001) and antecubital venous norepinephrine plasma concentration (100Ϯ64 versus 256Ϯ48 pg/mL, Pϭ0.01) were markedly decreased in addicted patients despite similar arterial blood pressure and heart rate. Opioid receptor blockade markedly increased MSA (5Ϯ2 to 24Ϯ3 bursts/min) and norepinephrine (49Ϯ12 to 305Ϯ48 pg/mL) and epinephrine (13Ϯ2 to 482Ϯ67 pg/mL) arterial plasma concentrations as well as mean arterial pressure (82Ϯ4 to 108Ϯ3 mm Hg) and heart rate (70Ϯ3 to 86Ϯ4 beats/min).
Conclusions-Chronic