I've lived in Indonesia and been to the Djarum factories where they make these. The conditions are nasty. They are hand-rolled. God knows what kind of germs come off the mouths of the women who make them.

And it's really best not to inhale. They will wreck your lungs in short order and they are highly addictive. If you have to smoke them, do it like a cigar. You get the taste without the nasty carcinogens.