Treating Nicotine Dependence with Nitrous Oxide/Oxygen (PAN)

This is an easy-to-read book for professionals and intelligent lay people alike. It outlines a revolutionary technique for treating substance abuse that has a firm scientific basis and which has helped thousands of nicotine, alcohol and other addicts in South Africa, Scandinavia and the USA. Physicians and dentists can improve their knowledge of substance abuse, while allowing dentists to treat nicotine dependence in dental practice. Insights from the book enables doctors to treat nicotine and other forms of substance abuse in a safe, rapid and effective way. Lay people would increase their knowledge on substance abuse and find interesting and informative insights into the technique. Professionals will receive practical details of the use of PAN (psychotropic analgesic nitrous oxide) for treating substance abuse with special emphasis on nicotine addiction. According to Prof Morris Clark, University of Colorado, Denver, and author of the current gold-standard textbook on the use of nitrous oxide for conscious sedation:‘Prof Mark Gillman is a pioneering researcher and leader in the use and application of nitrous oxide’ for treating substance abuse. Clark continues that Prof Gillman’s ‘opinion, experience and advice is much sought after worldwide. He received accolades for this ground breaking insight into this aspect on nitrous oxide use and readers of this text will appreciate the passion and the knowledge of the author and receive inspiration to stand on his shoulders and learn; also to illuminate this knowledge for their profession and their patients just as Mark Gillman has done over a lifetime.’

The need for this book was prompted by the wider understanding and recognition of the dangers of using tobacco products and the success by those of who have been treating substance abuse withdrawal with nitrous oxide/oxygen (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 a much wider use by almost all trained health professionals. 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. PAN (psychotropic analgesic nitrous) sedation is an approved treatment in South Africa and qualifies for medical insurance refunds. 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. 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. 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 (including the impact of 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. 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. It will also explain the reasons why, today, the terminology and definitions are still the source of debate. 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.

Prof Mark Gillman (a pioneering scientist) has led scientists at the SA Brain Research Institute (SABRI) in discovering a unique, low-tech method to investigate the endorphin system in man. They have been using psychotropic analgesic nitrous oxide (PAN), which are low concentrations of nitrous oxide mixed with high concentrations of oxygen so that the subject is always conscious throughout gas administration. By using PAN, Gillman and colleagues at SABRI discovered a unique, low-tech method to investigate the endorphin system in man. SABRI was founded in 1982, by Dr FJ Lichtigfeld and Prof Gillman on seed-money provided by Anglo-American and De Beers Chairman’s Fund. Gillman is the current CEO. Using PAN, he and scientists at SABRI, have researched diverse fields including pain perception, sexual function and substance abuse, resulting in over 300 scientific publications, including a number of books apart this book on nicotine abuse, including Envy as a Retarding Force in Science. Aldershot, UK: Avebury, 1996 and Nitrous oxide and Neurotransmission, Nova: New York, 2012. He is also author of a training CD on ‘Psychotropic analgesic nitrous oxide (PAN) for conscious sedation: Theoretical basis of practice).’ To put this in perspective, readers should be aware that the average scientist rarely produces more than 20 publications during their entire scientific career. He has been quoted in the international and local print and electronic media, including the BBC and SABC and has editorial appointments and consultanships at leading scholarly journals including Lancet, BMJ, New York Academy of Sciences, Biological Psychiatry etc. Prof Gillman has had numerous posts at local and international universities. Gillman has given more than 200 lectures to both lay and scientific audiences in Africa, North America, Europe and Australia. Achievement Highlights His team’s most fundamental scientific finding, was the discovery (between 1980-1983) of a new biological principle i.e. gases act as chemical messengers (neurotransmitters) between nerve cells. The new principle is termed gasotransmission, and seems to be a key element to the most basic life function of all i.e. respiration. It is also involved in controlling the circulation and the generation of memory. The discovery of a new biological principle is regarded by most scientists as one of the ‘Holy Grails’ of science because it occurs, at most, once or twice a century. These findings were confirmed a decade later by investigators at Johns Hopkins Medical School in the USA as well as in papers in Nature and Science. Gillman and colleagues have also made fundamental discoveries in the understanding of pain processing and drive states e.g. sexual function, and feeding (including anorexia nervosa and bulimia). Their work on the relationship between pain and sexual ecstasy seems to indicate that the philosophical link between pain and pleasure has a physiological basis. It has also uncovered a heretofore-unknown pain producing system, which could lead to the production of painkillers without the side effects related to morphine-like analgesics such as respiratory depression and addiction. A practical spin-off of their research has shown that PAN is a safe and useful treatment for acute addictive withdrawal states to all known substances of abuse. In 1992 it was approved by the S.A. Medical Association and is also officially recognised by the Health Professions Council. This treatment is unique in South African Medical History, being the first treatment that was officially recognised by the medical authorities in this country, which had been wholly conceptualised and developed in S.A. without any overseas input. Thousands of patients have benefited from the therapy in South Africa, Finland, and Germany and more recently in the USA for alcohol, nicotine opioids, cannabis (dagga), cocaine and benzodiazepines (e.g. Valium) abuse.