n2o: Treating Nicotine Dependence with Using Nitrous Oxide/Oxygen

Treating Nicotine Dependence with Using Nitrous Oxide/Oxygen (PAN) ( n2o ) : A manual for Health Professionals


The need for this manual was prompted by the wider understanding and recognition, particularly in South Africa, of the dangers of using tobacco products and the success by those of who have been treating substance abuse withdrawal with nitrous oxide ( n2o ) /oxygen in South Africa (also called PAN). Indeed, some trained physicians have been using nitrous oxide/oxygen sedation since the mid-1980’s to treat substance dependence including nicotine dependence. Because the technique is so safe and simple, once a short hands-on training course has been received, it lends itself to much wider use by almost all trained health professionals. Currently, very few health professionals will have the necessary medical background and knowledge to undertake nicotine dependence therapy without a manual which outlines the basis and principles of such treatment. I have therefore written a manual in order to give doctors, dentists and professional nurses the necessary knowledge and background to be able to treat nicotine dependence in a rational and effective manner with PAN in an outpatient setting. The use of PAN for treating nicotine dependence is ideally suited for primary health care, because unlike some other severe withdrawal states, which on occasion, can have severe acute sequelae, tobacco addiction does not present with severe acute withdrawal sequelae. It therefore can be safely used on almost all patients as outpatients. Furthermore, since suitably trained nursing sisters are allowed to administer nitrous oxide at non-anaesthetic doses, they too can assist patients to quit the use of tobacco. It thus gives the health practitioner (doctor, dentist and registered nurse) an easily applied method of helping their patients to quit.


Health professionals may not be aware that nitrous oxide/oxygen sedation, otherwise known as psychotropic analgesic nitrous (PAN) sedation is already listed in the HPCSA tariff list for medical practitioners. These codes are for treating alcohol and other withdrawal states viz., codes 0203/0204.


Assisting their patients to stop smoking or using tobacco products may be one of the most important contributions by health professionals to their patients’ health.

There is no safe dose of tobacco. In other words, no matter how little is used, tobacco products are potentially harmful to the users’ health.


Fortunately, there is some evidence that advice from health professionals about tobacco use and its dangers plus assistance with quitting has an important influence on patients’ decision to quit.

Synopsis of manual

Length: 28 000 words

Chapter 1 – Chapter one gives a general introduction to the topic of nicotine dependence and its aetiological relationship to diseases as well as an outline of the topics covered in the succeeding chapters.

Chapter 2 – This chapter gives a general outline of the epidemiology and incidence of the various systemic diseases associated with tobacco use. It also covers those diseases known to be associated with secondhand smoke. Knowledge of these conditions, many of which are potentially fatal, is essential in order for the practitioner to give well founded and appropriate advice to patients on the advisability of quitting.

Chapter 3 – This chapter covers, in some detail, the negative effects of tobacco on oral health, ranging from the trivial e.g. tooth staining to life threatening e.g. cancer. I have dealt with this aspect so that the manual will have some interest to dentists, who might wish to assist their patients to quit, since many dentists already have the expertise to apply nitrous oxide at the low doses consistent with PAN.

Chapter 4 – Here I deal with the general topic of substance abuse and dependence. This chapter will discuss substance abuse and dependence by looking at the terminology and underlying principles of substance dependence and abuse. This will be discussed using a historical perspective to enable practitioners to have a full understanding of the development of modern concepts. It will also explain the reasons why, today, the terminology and definitions are still the source of debate. In short, the same phenomenon can mean different things to different people and in certain cases are defined differently, depending on the disease classification used.

Chapter 5 – Chapter 5 looks at the neurobiology of substance dependence, including some simple neurotransmitter concepts, which gives a rational basis for understanding the use of PAN for treating nicotine dependence.

Chapter 6 – Chapter 6 gives a theoretical basis of the general principles and practical technique of using PAN and then focuses on its use for treating nicotine dependence.

Chapter 7 – The final chapter of the manual will discuss a schedule, detailing how to treat nicotine dependence, including the use of other adjunctive therapies (e.g. nicotine replacement) with PAN. Some basic psychological aspects of nicotine dependence are also discussed in this chapter.

Qualification of MA Gillman to write this book

I have been researching and publishing in the field of neuropsychiatry in partnership with a clinical psychiatrist for over 40 years. I am regarded as the world authority on the subject of using PAN for treating substance abuse. (‘Professor Gillman is a pioneering researcher and leader in research and application of nitrous oxide. His opinion, experience and advice is much sought worldwide.’ – Forward by Prof Morris Clark, senior author of the current standard textbook on nitrous oxide – Clark M, Brunick A. Handbook of nitrous oxide and oxygen sedation. St Louis: Mosby, 2014; now in its fourth edition).

I have lectured to lay and scientific audiences over 250 times. These lectures were local and international and often dealt with the use of PAN for treating substance dependence withdrawal. In 2006, I was invited to present, organise and chair a symposium at the 8th World Congress of Biological Psychiatry, (June 28th – July 3rd, 2005 in Vienna). The symposium was entitled ‘Psychotropic analgesic nitrous oxide (PAN): mechanisms of action and use for treating substance abuse withdrawal.’ The invitation came from the World Federation of Societies of Biological Psychiatry Association. All scientific papers presented at this symposium, have since been published.

Treating Nicotine Dependence with Using Nitrous Oxide/Oxygen (PAN)

I have held editorial advisory appointments to leading medical and scientific journals including Lancet, BMJ, International Journal of Neuroscience, Biological Psychiatry, Current Drug Abuse Reviews ,Brain Research etc.

I have over 300 publications including 5 full-length books and a best-selling CD, outlining the theoretical basis of the use of nitrous oxide ( n2o ) oxygen.


I visited China last year to act as an advisor to the Chinese Government who have introduced the use of nitrous oxide/oxygen (PAN) sedation to three governmental heroine treatment facilities in Ningxia.

Dr Gillman is refered to in the preface of “Handbook of Nitrous Oxide and Oxygen Sedation”.

Apart from my clinical qualification I also have a DSc in the subject of the clinical psychopharmacology of nitrous oxide, with particular reference to its use in treating substance dependence.

Dr Gillman is refered to in the preface of “Handbook of Nitrous Oxide and Oxygen Sedation”.

Dr Gillman is uniquely qualified to write a manual on the treatment of nicotine dependence with PAN for health professionals.

Dr Gillman is refered to in the preface of “Handbook of Nitrous Oxide and Oxygen Sedation”.