Online Nicotine Toothpick Vendors Ignore Age Restrictions

WASHINGTON, DC — Online vendors of nicotine toothpicks rarely verify the age of purchasers, whereas brick-and-mortar stores are more likely to ask for ID, according to a study of 77 stores and 16 online sites.

Online nicotine toothpick sales are “the Wild West” in terms of regulation, said Abhijeet Grewal, a research assistant at Cohen Children’s Medical Center, in New Hyde Park, New York, who presented the findings at the 2023 annual meeting of the American Academy of Pediatrics.

Nicotine toothpicks have become popular among teenagers as a relatively inconspicuous way to access the drug, Grewal said. The nicotine content of the toothpicks varies, but many contain as much as 2-3 mg per pick compared with the 1.1-1.8–mg amount inhaled per the average cigarette, he said. The cheap price and teen-friendly flavors like cherry and mocha add to the appeal of the picks. However, data on the marketplace and accessibility of these products are lacking, Grewal said.

To find out how easily youth can buy nicotine toothpicks through in-person and online channels, Grewal and colleagues identified and called 404 brick-and-mortar retailers across the United States by phone and asked whether they required ID for purchase of nicotine toothpicks; of the 77 locations that responded, only one said that they would sell nicotine toothpicks without asking for proof of age.

The researchers also collected data on 16 vendor websites that sold nicotine toothpicks with shipment to the United States (identified from pixotine.com).

Overall, 11 sites (69%) prompted users to confirm that they were aged 21 years or older to either view the site or place orders, but 12 sites (75%) required no formal method of verification.

Warnings or disclaimers, such as “nicotine is an addictive chemical”, appeared on 69% of sites. Marketing statements including terms such as “discreet” and “cost-effective” to describe the toothpicks, Grewal said, and online reviews endorsed the products as “convenient” and “rich in flavor.”

The sites in the study offered a total of 32 different flavors, Grewal said, and 44% of the sites offered some type of discount on prices, which land in the range of approximately $5 for a tube of 20 toothpicks.

Nicotine toothpicks and flavored toothpicks without nicotine were originally marketed as smoking cessation aids, said Grewal, but their low price point and ability to be consumed discreetly makes them appealing to teens for nicotine use in many environments.

More research is needed to characterize youth use of nicotine toothpick products, as well as purchasing patterns, he said. However, the results highlight the need for regulation of nicotine toothpick vendors to protect youth from accessing nicotine in this form, he said.

Ask Adolescents About Toothpicks

“While nicotine replacement therapy products may be an effective way for people to quit smoking, these products have the potential to introduce minors to nicotine in a seemingly innocent way resulting in dependence,” said senior author Ruth Milanaik, DO, also of Cohen Children’s Medical Center, in an interview. “Many children are intrigued by these fun flavored products, and our team was interested in examining the availability of these products to minors.”

Overall, “our team was quite pleased with brick-and-mortar stores spoken requirements of age verification for purchase, and quite worried about the availability of nic picks through online vendors,” she told Medscape Medical News.

Clinicians, educators, and parents should be aware of the existence of nicotine toothpicks and the ease in which minors can attain them through online vendors, Milanaik said. “While NRT is a part of smoking cessation programs, nicotine toothpicks should not be used by minors without clinical reasons,” she said. “The innocuous and innocent nature of these toothpicks may entice minors to try and regularly use these without regard to future dependence.”

The study received no outside funding. The researchers had no financial conflicts to disclose.

American Academy of Pediatrics 2023: O2083: Nic Picks: Analyzing Age Verification Procedures for Nicotine Toothpicks Vendors. Presented October 21, 2023.

Heidi Splete is a medical journalist based in Washington, DC, with more than 20 years of experience in writing for clinical and general audiences

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