The pharmacists involved, such as Edward McManus, a pharmacist in Ballymun, Dublin, believe that they cannot back down in the dispute because they are fighting for the very survival of their businesses.

The dispute was sparked by the decision taken by the HSE last month to reduce the wholesale margin it pays on prescription medicine from 17.65% to 8% from 1 December.

This margin is paid by the HSE to pharmacies, which then pass it on to wholesalers.

However, the wholesalers have refused to cut their prices to accommodate the lower margin, meaning that pharmacists will lose out, particularly those whose business is built on the state medical card scheme.

"We have no problem with cost containment, " said McManus, who owns two pharmacies. "But we have a problem when the proposals are skewed against medical card pharmacies. The payments which we get from the scheme are tiny and it only functions because it is subsidised by rebates from the wholesalers."

McManus said, however, that the dispute over the methadone scheme had already been brewing before the margin cut announcement, particularly because pharmacists felt their safety was being compromised by penny pinching by the HSE.

"The HSE promised to give us [the pharmacists in the scheme] Hepatitis B vaccinations earlier this year. In fact, they even issued a press release to that effect but when you try to claim your vaccinations, you are just sent from Billy to Jack, " he said.

Pharmacists involved in the scheme are also entitled to a security grant of 6,350 every five years because methadone is particularly attractive to drug thieves. But McManus said while he has applied for the grant twice, he has never received it despite being attacked on numerous occasions.

"So, we had come to the end of the road with the HSE on the methadone scheme anyway, particularly when they wouldn't talk to us about vaccinations and security. Then the margin cut came."

McManus said that his 50 methadone patients were surprisingly supportive of his participation in the dispute. "They were quite understanding. It was a very difficult step for me to take from a number of perspectives, not least the personal relationship I had built with my customers over the years."

Although McManus hasn't been raided by the Competition Authority, who are investigating claims by the HSE that the dispute represents an illegal cartel, Phibsboro pharmacist Richard Collis has.

Collis' family have been in the pharmacy business in Dublin since 1898 but he fears that the family tradition may end with him if the HSE has its way. For him, the HSE's decision to stop negotiating fees and conditions with his professional body, the Irish Pharmaceutical Union, was the last straw.

"There's an absolutely fundamental issue for me. I as an Irish citizen have the right to be represented by my union and that right has been taken away from me by the HSE, " he said.

Collis, who has emerged as the spokesman of the rebel pharmacists, was one of the first pharmacists to become involved in the methadone scheme but said he had become unhappy about the HSE's attitude towards the security of his staff. "My staff have been held up at knife point twice in the past 12 months.

The HSE promised me financial aid in that area and it never came. They also promised me Hepatitis B vaccinations that never showed up too, " he said.

Collis described the HSE's complaint to the Competition Authority as "probably as crude an act of intimidation as I've ever come across. It reflects badly on the management of the HSE."

Like McManus, Collis believes that there is scope for reforming the state's drug schemes, particularly as "we are doing the same work in different schemes and get paid different rates for it".

"I think we should streamline the schemes so you get paid the same rate for each. It is the fairest way forward, " he said.

When asked what effect the HSE margin cut would have on his business, which consists of a single shop, Collis said he preferred not to think about it while a major dispute was going on. The 140 pharmacists involved in the dispute represent roughly half of the entire number involved in the methadone programme. Others, mainly larger outfits, have remained out of the dispute.

According to Mary Rose Burke, chief pharmacist of Boots Ireland, the company had decided "after carefully weighing up the various options involved that it was in the best interests of our patients to continue to supply methadone". She said, however, that Boots would urge the HSE to engage in "meaningful negotiations with the IPU".

The HSE, however, said that while it could discuss a wide range of issues with the IPU, it was barred under competition law from talking to them about fees, which it believes is the main issue behind the protest.

The situation is further complicated by the fact that, to avoid breeches of competition law, the IPU did not order the action and the pharmacists decided individually to participate in it, making a resolution more difficult.

A HSE spokesman said that its decision to cut drug margins was "an intelligent attempt to ensure savings were made for the taxpayer and put back into patient care".

He said that, from its point of view, the most striking feature of the dispute was how "pharmacists have decided to target a group of patients who have nothing to do with the main dispute. Do they feel it is socially acceptable to do so?"