Nicotine levels in emissions from heat sticks without tobacco exceed health-based advisory values: A chemical-analytical study

INTRODUCTION: Heated tobacco products (HTP) are tobacco-containing sticks that have been on the market for some time and are heated in a device to release a nicotine-containing aerosol for inhalation. Recently, new sticks have emerged that contain nicotine but no tobacco and are available in several flavors. These nicotine sticks closely resemble tobacco sticks in appearance and use, but contain nicotine, a non-tobacco carrier such as cellulose or Rooibos tea leaves, and other additives, including flavorings. As they do not contain tobacco, these products are currently not regulated under the European Union Tobacco Products Directive (EU TPD). Since the nicotine levels in these products are unknown, this study aimed to measure the nicotine concentrations in both the contents and emissions of nicotine heat stick brands marketed in the Netherlands. METHODS: This chemical-analytical study was conducted in March 2025. Two flavor variants from two major brands were analyzed for nicotine content in both sticks and emissions. Emissions were generated and collected with a smoking machine following the World Health Organization (WHO) Intense regime. All extracts were analyzed for nicotine by gas chromatography-mass spectrometry. RESULTS: All sticks contained nicotine (3.2-3.8 mg per stick), with no detectable 6-methylnicotine. Emissions analysis showed each stick released 0.7-1.0 mg nicotine under standardized conditions. CONCLUSIONS: Nicotine heat sticks without tobacco deliver nicotine doses comparable to HTPs. The measured levels exceed health-based advisory values for nicotine exposure from nicotine products without tobacco for inhalation, as reported by the Dutch National Institute for Public Health and the Environment (RIVM), by a factor of 18-25. If these advisory values are implemented in tobacco legislation, nicotine heat sticks products will no longer be permitted. These limits would apply to all nicotine products without tobacco for inhalation that are not covered by the EU TPD, except e-cigarettes.