Cough Syrups in India: A Case of Overprescription and Underregulation

Behind India’s Cough Syrup Scare: How Overuse and Poor Oversight Triggered a Health Crisis

Cough syrups have been a staple in Indian households for decades. They also act as a first line of defense against a persistent cough or seasonal cold. But behind this trusted remedy lies a growing public-health concern. Recent reports of toxic cough syrups linked to child deaths have once again exposed the critical issues in India’s pharmaceutical system. It combines overprescription, quality lapses, and inadequate regulation.

Lethal Cough Syrup

 
The World Health Organization (WHO) has issued a safety warning against three cough syrups manufactured in India after several child deaths were reported in Madhya Pradesh. The health governing body has identified three such syrups in India, urging authorities to report back to the health agency in case they detect any of them in their countries.

 Central Drugs Standard Control Organization (CDSCO), reportedly informed the WHO that the syrups contained toxic diethylene glycol (DEG) in quantities nearly 500 times the permissible limit, and were consumed by children, all under the age of five, who recently died in MP.

 The state-based drug controller reported “poorly qualified staff”, “substandard water and equipment”, “lack of pest control”, “missing production monitoring procedures”, and “no quality assurance or data collection department” in the manufacturing units.

 "Manufactured products are stored in a very unhygienic manner...Sewage was discharged without purification. Water for drug production was stored in an unhygienic manner," the report stated.

Dark History of India-made Cough Syrup

 
When consumed, DEG can cause acute kidney failure, especially in children. Sadly, this isn’t the first such case. Similar incidents in the past, from Gambia to Uzbekistan, have drawn global attention to India’s export-quality controls, while domestic oversight remains patchy and reactive.

 Indian-made cough syrups have come under global scrutiny several times in recent years. In 2023, Indian syrups were linked to the deaths of 70 children in Gambia and 18 in Uzbekistan.

 At least 12 children under five died in Jammu in Indian-administered Kashmir, allegedly from cough syrup between December 2019 and January 2020.

 Regulators have found the presence of toxic diethylene glycol in all those India-made syrups.

 The Overprescription Problem

Doctors in India often face heavy patient loads and limited consultation time. In such conditions, prescribing a syrup feels like an easy solution to soothe a patient’s concern, even when it may not be medically required. Most coughs are viral and cure within a few days. However, doctors often prescribe syrups containing multiple active agents across India.

 Many pharmacies often sell these medicines without valid prescriptions. Although the Drugs and Cosmetics Act (Schedule H) does not allow the sales of certain medicines, the implementation of rules has not been strict across the nation.

 
Manufacturing Gaps and Regulatory Loopholes

The CDSCO oversees manufacturing standards in India. But lack of resources often lead to fewer inspections and less frequent audits.

 Contamination often occurs from raw materials, where costlier ingredients are replaced with cheaper ones. Without extensive testing, these toxic medicines can be introduced into domestic and foreign markets.

 Although regulators have ordered factory shutdowns and enhanced lab testing, the damage to public confidence is already done. Experts say India’s drug regulation remains reactive rather than preventive.

 The Global Ripple Effect

 
The World Health Organization (WHO) has issued global alerts and pushed for stronger quality controls. This has broader implications for India’s pharmaceutical reputation, which has long been its economic pride. 

 The same factories that supply life-saving medicines abroad cannot afford even a single lapse in safety. Transparency, traceability, and international compliance are no longer optional; they are non-negotiable.

 
What Needs to Change

Fixing the problem requires reform on three levels: clinical practice, retail behavior, and manufacturing oversight.

 Medical associations must introduce evidence-based cough treatment, as most mild coughs do not need medication. Also, no children should be prescribed codeine-based syrups.

 Retailers should strictly follow prescription regulations. State drug controllers can adopt digital tracking for Schedule H drugs to detect irregular sales.

 Manufacturers must perform mandatory tests and reveal raw material sources. Regular audits can prevent large-scale harm.

 It also demands public awareness. People must learn that more medicine does not always provide better treatment. Patients sometimes need sufficient rest, hydration, and diet to recover faster.

 
The Path Forward

 
The recent tragedies are a critical alarm for India’s healthcare system. The government’s quick response and stricter monitoring are a step in the right direction. 

 Every change needs consistent effort from various sectors. The processes should have qualified inspectors, maintain strict record keeping of medicines, and employ severe punishments for non-compliance.
 
Medicines represent safety and care. It should not involve risk and uncertainty. Ensuring that every medicine meets global safety standards is not just good regulation; it is a moral duty.

Conclusion

 
India’s cough syrup crisis reveals a deeper truth: access without accountability can be dangerous. Over-prescription feeds overuse, under-regulation leads to negligence, and the cost is paid in lives. The solution to this problem is integrity, transparency, and science-backed policy, so that the simple act of curing a cough never becomes a cause for heartbreak again.