The contemporary water abstraction licence (WAL) regime in Italy is no longer flexible enough to cope with the challenges posed by human-induced climate and global environmental changes. To cope with mounting water stress risk, the reformed WAL policy policies should i) foster sustainable levels of water withdrawals, ii) relate the water abstraction entitlements to medium- to long-term natural availability, and iii) foster efficient use of water resource and re-allocation of entitlements. The fundaments of the WAL regime in Italy remained essentially unchanged since the 1930s. The sole noteworthy change was the decentralization of the regulatory competences from the state to the regional authorities in the late 1990s. As a result, the WAL administrative frameworks nowadays vary across the Regions. The main differences lie in the concession-free entitlements, the administrative practices, and the levels of water concession fees. In this paper we review the WAL regimes across the Regions in the Po River Basin District (PRBD), and outline the principles of a reform that promote water security.