SINGAPORE - People who use “energy stick” inhalers can progress to smoking and vaping, and may also suffer from respiratory problems and long-term health damage, said healthcare experts.

The inhalers – about the size of a matchbox – are slowly finding their way into the hands of young people, largely due to social media marketing tactics aimed at youth and students.

Similar in appearance to illegal e-vaporisers, they come in flavours like watermelon, mango and grape, and feature two prongs that users insert into their nostrils for them to take a whiff. The prongs house two porous strips soaked in liquid.

The flavoured additives found in these nasal inhalers are added to the product and marketed as “healthier” and “more natural”, but there are limited studies to back these claims, said Dr Sewa Duu Wen, head and senior consultant of respiratory and critical care medicine at Singapore General Hospital.

“In fact, there is broad literature suggesting some of these flavouring compounds contribute to airway toxicity, impaired respiratory immune cell function and cause cellular damage,” he said.

He added that while these flavours are not addictive, their use in other products like cigarettes and vaping products has been linked to increased use by adolescents, and may pose uncertain long-term health hazards.

Checks by The Straits Times found these inhalers could be bought on e-commerce websites at prices as low as $1.50.

On March 4, the energy sticks issue was brought up in Parliament, when Mr Yip Hon Weng (Yio Chu Kang) asked about the effects of these inhalers and whether they should be treated like vaporisers and e-cigarettes. Vaporisers and e-cigarettes are banned in Singapore.

Mr Zhulkarnain Abdul Rahim (Chua Chu Kang GRC) asked about the use of such products among young people in Singapore, and their role as gateway devices for drug abuse.

Senior Minister of State for Health Janil Puthucheary, in his reply, said the Health Ministry and Health Sciences Authority are closely monitoring the use of energy sticks marketed on social media with a range of flavours to target the young.

He said the inhalers claim to give users an energy boost and contain ingredients similar to those of conventional nasal decongestant inhalers. He added that steps may be taken if they are found to contain harmful ingredients like nicotine.

He said: “We will continue to evaluate these products to ensure that they are not adulterated with harmful ingredients such as nicotine as they evolve, and we will take the necessary actions to protect public health.”

The nasal inhalers, which are touted as having health benefits such as clearing nasal congestion, helping to reduce anxiety and improving sleep quality, have become widely popular among schoolchildren, especially in Malaysia and China.

Across the Causeway, Malaysia’s Health Ministry said it will be taking action against sellers. Malaysian daily The Star reported that one seller said some of the products contain hemp, which is listed as a controlled drug.

Malaysian Pharmacists Society president Amrahi Buang also told The Star that the energy sticks could be a gateway to developing smoking or vaping habits among children and teenagers.

He added that inhalers sold at pharmacies for medicinal purposes are different from energy sticks, which are sold online, mainly through social media platforms.

A listing found on online retailer Shopee attracted more than 4,200 buyers, and had an average rating of 4.8 stars. After this reporter made a purchase, it was a two-week wait until it arrived from China.

Said Dr Sewa: “Some of these products found online are produced by companies with unclear quality control standards and may not be subjected to the same rigorous regulations placed in more established companies.”

According to the product label, ingredients in the inhaler include menthol, Borneo camphor and food flavouring.

The ingredients are found in certain regulated health products that have been approved by the United States Food and Drug Administration to be used for relieving nasal congestion symptoms, said Dr Sewa.

However, he added that other touted health benefits, such as improving sleep quality and reducing fatigue, are not established.

He said: “When these ingredients are absorbed in large quantities in children, the potential to cause side effects may be more evident, compared with the adult population.

“Hence, it is advisable to avoid using these products in very young children less than six years old.”