India makes it easy to access opioids. Prescription-only rules often aren't enforced, and cheap painkillers like tramadol and tapentadol are sold over the counter. India also makes it hard to access opioid treatment. The main treatment, opioid agonist therapy, is cheap and works well, but fewer than 2% of people addicted to opioids get it, compared with more than 80% in France. Private psychiatrists are technically allowed to prescribe it, but the drug sits under four conflicting laws and some doctors have been arrested for prescribing it without the right licenses, so almost none offer it. Official policy also pushes patients off the medication within a year or two, even though it's generally recommended people stay on it long term. And more than three quarters of patients at government clinics receive a dose below the WHO's recommended 8 to 24 mg a day. As a result the rate of opioid use is about three times the world average, and at least 77,000 people die from drug-related causes each year. Underdosing and rushing people off the medication makes relapse more likely. That's dangerous, because when someone relapses their tolerance has dropped but their cravings are still strong, so overdoses are more likely.