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A global review of SLT-related diseases indicated a 20% higher risk of esophageal cancer among SLT users, with the highest risk observed in studies from the Eastern Mediterranean Region (EMR) and SEAR.[27,28] A meta-analysis of Indian studies also showed a positive association between SLT use and esophageal cancers.[29] In a study by Chitra et al ., which included 90 patients with biopsy-proven squamous cell esophageal carcinoma, bidi and cigarette smoking, as well as paan/tobacco chewing, were identified as independent risk factors

They are not as commonly found as pre rolls in dispensaries, but they can still be purchased or prepared using a blunt roller for convenience and consistency