Easy Accessibility of Prescription-Only Medicines in India: A Persistent Public Health Challenge

Dear Editor,

Easy and often unchecked access to prescription-only medicines remains a major but underrecognized public health concern in India. Despite existing regulatory frameworks under the Drugs and Cosmetics Act, prescription medicines, including antibiotics, corticosteroids, psychotropics, and cardiovascular drugs, are frequently dispensed without valid prescriptions across retail pharmacies and informal drug outlets.^1,2 Factors such as limited access to primary healthcare, long waiting times, financial constraints, and public perception of pharmacies as first contact healthcare providers have encouraged widespread self-medication. While this practice may offer temporary symptom relief, it increases the risk of inappropriate drug selection, incorrect dosing, adverse drug reactions, masking of serious illnesses, and delayed medical consultation.

The public health consequences of this practice are substantial. Unrestricted antibiotic access has been a major driver of antimicrobial resistance (AMR), a growing crisis in India that threatens the effectiveness of standard treatments and increases healthcare costs and mortality.^1,3 Similar concerns extend to corticosteroids, opioids, and benzodiazepines, where unsupervised use contributes to metabolic complications, immunosuppression, drug dependence, and misuse.^2,4 In cardiovascular care, inappropriate initiation or discontinuation of antihypertensive and antiplatelet therapy without medical guidance can result in severe outcomes such as stroke or myocardial infarction. Although regulatory measures such as Schedule H1 have been introduced, inconsistent enforcement, inadequate pharmacist training, and limited public awareness have restricted their effectiveness.⁴

Addressing this issue requires a balanced and system-based approach rather than regulation alone. Strengthening primary healthcare services, improving the availability of qualified medical professionals, and integrating community pharmacists into regulated care pathways may reduce dependence on unsupervised medication use. Public education initiatives highlighting the risks of self-medication and stricter enforcement of prescription laws are equally important. Empowering pharmacists through standardized training programs to function as responsible gatekeepers rather than informal prescribers could further enhance patient safety. In conclusion, the easy accessibility of prescription-only medicines in India represents a significant yet preventable public health challenge, and coordinated efforts at policy, healthcare system, and community levels are essential to promote rational and safe drug use.