Gutkha use can begin at a very young age. Due to its often flavorful taste, easy availability and cheapness, it is popular with poor children, who can exhibit precancerous lesions at a very early age as a result. Symptoms of cancer often appear by high school or college age. Social custom does not permit children in India to smoke cigarettes, so gutkha use, being all but invisible to others, is the method of choice. Gutkha is also used by many as an alternative to cigarettes and is claimed to curb the need to smoke but eventually becomes another habit tough to quit. Gutkha also causes swallowing problems during night time sleeping leading to dry throat and restless sleep. This may eventually lead to throat cancer in addicts[citation needed].

In 2008 about 5 million children under 15 were addicted to gutkha. A survey in Uttar Pradesh and Madhya Pradesh yielded precursor of mouth cancers in 16 percent of the children.

Excessive gutkha use can eventually lead to loss of appetite, promote unusual sleep patterns, and loss of concentration along with other tobacco related problems[citation needed].

A gutkha user can easily be identified by prominently stained teeth ranging from dirty yellowish-orange to reddish-black. The stains are difficult to remove by normal brushing and usually need the attention of a dentist[citation needed].

After gutkha is consumed, it is generally spat onto a wall or at the ground, causing an unsightly red stain that is quite resistant to the elements. Some building owners have taken to combating this unpleasantness by painting murals of gods on their walls, with the idea that gutkha chewers would not spit on a god[citation needed].

On 1 August 2002, Maharashtra State took the unusual step of placing a five year ban on all use of gutka (as a potentially hazardous foodstuff), and an active black market persisted until the order was overturned by High Court of Judicature at Mumbai on the grounds of unfair trade practice