India's Cough Syrup Crisis: A Deadly Pattern of Contamination and Misuse

It's happening again.

In early September, a cluster of unexplained child deaths in a small town in Madhya Pradesh sent local health workers scrambling. At least 11 victims—aged one to six—had died within days of taking a common cough syrup. Officials tested everything from drinking water to mosquitoes before the truth emerged: their kidneys had failed.

Weeks later, a state laboratory in the southern city of Chennai confirmed the worst. The syrup in question contained 48.6% diethylene glycol, a toxic industrial solvent that should never be found in medicine. Kidney failure is common after consuming this poisonous alcohol.

The horror wasn't confined to Madhya Pradesh. In neighbouring Rajasthan state, the deaths of two young children, allegedly after consuming a locally-made Dextromethorphan syrup—a cough suppressant unsafe for very young children—sparked outrage and a government investigation.

This brought a grim sense of déjà vu for India.

Over the years, diethylene glycol in Indian-made cough syrups has claimed dozens of young lives. In 2023, Indian syrups tainted with diethylene glycol were linked to the deaths of 70 children in The Gambia and 18 in Uzbekistan.

Between December 2019 and January 2020, at least 12 children under five died in Jammu, with activists suggesting the number could be higher. Past incidents have also included abuse of cough syrups containing codeine, a mild opioid that can produce euphoria in high doses and lead to dependence. Each time regulators promise reform, contaminated syrups reappear—reflecting a fragmented drug market and, critics allege, a weak regulatory system struggling to oversee hundreds of low-cost, often unapproved syrups produced by smaller manufacturers and sold over the counter.

Days after the latest child deaths, India's health ministry urged rational use of such medicines—effectively warning doctors to exercise more caution when prescribing them to young children—seized samples of the syrup, suspended and banned sales, and ordered an investigation.

Critics argue that every new tragedy exposes the rot in India's drug oversight system—a maze of weak enforcement and regulation. The Indian cough syrup market is set to soar from $262.5 million in 2024 to $743 million by 2035, growing at a compound annual rate of 9.9%.

But this growth raises concerns, as many of these syrups do little good and can potentially do serious harm. Marketed as quick relief for sore throats and stubborn coughs, the sweet syrups combine sugar, color, and flavoring with a cocktail of antihistamines, decongestants, and expectorants, but evidence of their efficacy is limited.

Most persistent coughs in children in increasingly polluted Indian cities are not caused by infections but by allergies and irritation of the lower airways, often triggered by dust and smog.

In rural India, where healthcare access is limited, many patients turn to informal practitioners or even shopkeepers for medical advice. This reliance often leads to the over-prescription of cough syrup, driven by parental anxiety and a lack of medical knowledge.

Experts stress the need for reform in prescription practices and regulatory oversight to prevent further tragedies.