SINGAPORE, March 11 — Priced under S$5 (RM17.60) and boasting flavours like "power mint” and "succulent grapes”, a new breed of nasal inhalers, known as energy sticks, that claim to give users an energy boost and relieve nasal congestion is catching on among Singapore’s youths.

Speaking to TODAY, two sellers of energy sticks in Singapore say their clientele are mostly under 25, and some are as young as 12.

Many are also repeat buyers, or those who buy in bulk and sell it on to their schoolmates, they said.

But are they really what they claim to be? These devices were put in the spotlight after two Members of Parliament asked the Ministry of Health (MOH) last week if it was monitoring their use among youths, and whether such products should be treated like vapes and e-cigarettes.

In Parliament on Monday (March 4), Senior Minister of State for Health Dr Janil Puthucheary said that MOH and the Health Sciences Authority are "closely monitoring” the use of energy sticks, given its marketing on social media and availability of flavours that "target the young”.

He added that the authorities are seeking to ensure that they are not adulterated with harmful ingredients, such as nicotine. The addictive substance is commonly found in vapes and e-cigarettes, as well as smoking cessation products.

Based on online reports, these energy sticks are widespread in Malaysia and have sparked concerns about being used by youths as a gateway to smoking and vaping.

To find out why these devices are raising eyebrows among experts, TODAY takes a closer look at what they are, their potential health risks, and why experts caution against their rising popularity among youths.

What are energy sticks?

Often referred to as "energy sticks” or "energy bars”, these nasal inhalers can be found on e-commerce platforms like Shopee, Lazada and Carousell for around S$1.19 to S$4.50.

They typically come in compact, bright-coloured packaging and various listings of the inhalers boast flavours such as peppermint, peach and even alcohol-themed names like "mango vodka”.

Given the numerous nasal decongestants that are already on the market for years, nasal inhaler products are not new, said experts.

But Dr Ker Liang, the medical director of Aglow ENT Centre, said energy sticks have rebranded the familiar product with "trendy, eye-catching designs”. ENT stands for ear, nose and throat.

A common nasal decongestant, Vicks, states on its packaging that it can clear a "stuffy nose” and make breathing "feel clear and cool” using menthol and camphor as active ingredients. The advertising for energy sticks, on the other hand, go further in the claims.

Listings for energy sticks would tout how such devices can be used for on-the-go refreshment when one is drowsy in class, or while driving.

How safe are energy sticks?

A search for energy sticks on e-commerce sites by TODAY also revealed how sellers ascribe various health benefits to their products. This includes helping users quit smoking, breathe "deeper” and also manage their snoring.

But beyond these claims, there are many similarities shared by both types of nasal inhalers.

In terms of ingredients, Dr Puthucheary told Parliament that energy stick nasal inhalers contain substances similar to conventional nasal decongestant inhalers.

Experts agreed with such an assessment, adding that studies on the medical benefits of ingredients in conventional nasal decongestants are limited. In both cases, excessive use may irritate the airways, they said.

"There is not a whole lot of difference in the concept behind ‘energy sticks’ and our traditional inhalers. Oil based chemicals, be it menthol, essential oils...are breathed in and interact with receptors in the nose,” said Dr David Chin, an otorhinolaryngologist from Parkway East Hospital.

"The difference is the diverse ingredients now available, giving a variety of different scents and possibly different effects. The term ‘energy’ is probably more a marketing term than a description of a new technology.”

In the case of menthol, though studies suggest that people feel they breathe better after using the products, actual measurements of airflow do not show significant improvement, said Dr Chin.

Mr Sean Ang, a smoking cessation counsellor and pharmacist from Success Alliance Enrichment, also said that while menthol triggers receptors in the nose to give the sensation of cool air, it has no effect in opening blocked nasal airways.

As there is unknown "quality control” of another common inhaler ingredient, plant essential oils, there is a chance that the oils used may contain allergenic components that can bring adverse effects for "vulnerable consumers” like pregnant women, said Professor Eric Chan, from the Department of Pharmacy and Pharmaceutical Sciences at the National University of Singapore (NUS).

Professor Philip Eng, a senior consultant respiratory physician at Mount Elizabeth Hospital also said that users of Vicks VapoRub should be wary about excessive usage.

He highlighted a 2016 study in the journal BMC Ear, Nose and Throat Disorders that linked an 85-year-old woman’s contraction of a form of pneumonia that is "very difficult to diagnose” to her long-term application of Vicks VapoRub to her nostrils.

How legitimate are the health claims?

In any case, established brands like Vicks have to state their active ingredients on the packaging. But experts warn that the same is not the case for energy sticks, which typically do not list out their ingredients clearly. The production and monitoring of what goes into energy stick inhalers are unregulated areas, they said.

"It is very tempting to buy a simple device that is cheap and (claims to) provide many wonderful health benefits. We, as consumers, should exercise caution when purchasing products lacking ingredient transparency, especially when claiming medical benefits,” said Dr Ker.

She added that those with persistent nasal congestion or excessive tiredness should seek medical help, as they may signal undiagnosed rhinitis or sleep apnea, which are conditions that can be treated easily and safely.

Then, there are also the outlandish claims made by some online sellers about these devices.

One listing on Lazada said that the nasal stick had "regenerated 96.3 per cent lung tissues” and "91.5 per cent healed respiratory tract infections” after four weeks, based on "clinical trials and reports”.

Such claims are misleading, and some are "downright false”, said Mr Ang, as there is no evidence that energy sticks can bring such benefits and advertisements saying clinical research has been done does not always mean research was done properly, if at all.

"These energy stick nasal inhalers are not registered. Therefore, the actual ingredients are unknown and may differ depending on the source of these sticks,” said Dr Stephen Lee, a specialist and consultant at Raffles ENT Centre.

Without knowing what goes into these inhalers, experts caution that they may contain harmful substances similar to those in cigarettes and vaping devices, which could exacerbate respiratory conditions and lead to addiction.

Across the Causeway, Malaysia’s health ministry said in a Feb 8 statement that it would take enforcement action to ensure product advertisements of energy sticks are taken down from e-commerce sites in response to public complaints.

The energy sticks have also been trending in China since October last year, with some listings of such products on Chinese online shopping platform Taobao with more than 10,000 sales to date.

In December 2023, the Tianjin Consumers Association on its official WeChat account recommended the installation of signs warning about the health risks of energy sticks in primary and secondary schools in China.

What are e-commerce sites doing about them?

In response to TODAY’s queries, a spokesperson from Carousell said that the platform is working closely with local authorities to understand the harm of energy sticks and will review further action following guidance from the authorities.

Carousell uses both automated and manual moderation methods to detect prohibited items and users are encouraged to report prohibited items, which will be reviewed within 24 hours.

"We do not allow listings of medicinal and healthcare products or services that claim to treat or cure any condition which requires the attention of a registered medical or other qualified practitioners,” said the spokesperson.

A spokesperson from Lazada said that the platform fully complies with regulation set by Singaporean authorities and "continually (updates)” their algorithms to weed out and disable listings against their seller marketplace policy.

"Products that cannot be advertised according to local laws, regulations, and advisories, including product listings that contain false, misleading, or exaggerated statements, are also not allowed,” said Lazada.

How popular are energy sticks among youths?

Two energy sticks sellers told TODAY that most of their buyers are young and often between the ages of around 12 to 25.

An 18-year-old student, who wanted to be known only by his surname Goh, started selling them on e-marketplace Carousell around three months ago after seeing the product on a Chinese supplier’s page.

He has since sold around 200 units at S$3.50 to S$4.50 each per month, with many repeat customers being students.

"So far sales have been increasingly high... to the point that it is overwhelming and customers are reserving the next batch of orders before new stock arrives,” said Goh.

Some buyers are secondary school students who buy 10 to 15 energy sticks at a time and distribute their bulk purchases in school.

Goh said he also records usernames of young repeat buyers and prevents users under the age of 18 from continuing to make bulk purchases.

Mr Ang from Success Alliance Enrichment noted that many listings for energy sticks offer free lanyards and have flavours and colours "clearly targeted at the youth”.

"Combined with how trendy it is becoming, it could become cool to have such a device hanging around your neck and a ticket to being part of a community of users,” he added.

What are the risks to youths?

Dr Chin from Parkway Health said youths who use such devices may end up on a slippery slope towards more harmful habits.

Even if the inhalers do not contain addictive substances, experts expressed concern that regular use of such products could be the gateway to other inhalable substances like vapes.

"From a medical perspective, if these energy sticks do not contain additive ingredients, consumers may indeed not be addicted to the use of the inhalers,” said NUS’ Prof Chan.

"However, the same cannot be said from a socio-economic perspective, as consumers may end up with a habit or lifestyle that eventually gravitates them towards the use of vapes, e-cigarettes or smoking cigarettes.”

Behavioural patterns, such as frequent "hand-to-nose” actions, may result in a physical dependence on the device, said Mr Ang.

"At the end of the day, if the harm becomes irreversible, we’re subjecting our youth to long term respiratory conditions that might surface later in life. The risk isn’t worth it based on the claims, as there are much safer, well researched products that can help.” — TODAY