Scotland must iron out variations in pharmacy-based opioid treatment, an independent review has urged.

The expert review, commissioned by the Scottish government and published yesterday (August 22), backed pharmacy's role in opioid replacement treatment, but warned there were "huge inconsistencies" in primary care.

The research team – led by Brian Kidd, clinical senior lecturer in addiction psychiatry at the University of Dundee – argued that providers' ability to opt-in to tdrugs services in primary care was driving health inequalities. They called for a nationally agreed specification of pharmacy services for problematic drug users to ensure a "high-quality and consistent service".

The review argued that providers' ability to opt in to opioid treatment in primary care was driving health inequalities	More on methadone Scottish police want debate on inner-city methadone       dispensing MPs call for alternatives to methadone to be explored MSP's ‘methadone millionaires' claim branded a       disgrace MORE NEWS
	Researchers also recommended reviewing pharmacy payments to ensure they delivered the best value possible. There was a logical argument for treating opioid replacement therapy as a separate element in pharmacy payment negotiations, they said, but acknowledged that reimbursement was a complex issue.

The review called for the government to start putting in place a "clear direction for improvement work" by early 2014.

The researchers stressed that they had no criticism of the use of opioids, which were an effective, evidence-based addiction treatment, despite the "degree of enmity" towards them.

Methadone treatment attracted harsh criticism in November, when Labour MSP Jenny Marra accused some pharmacists of being "methadone millionaires" who profited from recovering addicts at taxpayers' expense.

As well as reimbursement for the methadone supplied, pharmacies may also receive dispensing and supervision fees set locally by the relevant health board.

Community Pharmacy Scotland (CPS) welcomed the review's backing of opioid treatments, but warned that changing the payment system could be "tricky" and urged the government to focus on the value pharmacies provided.

Stuart Notman, methadone expert and owner of Stuart Notman's Pharmacy, Aberdeen, said any changes to the methadone treatment programme should give more weight to pharmacy's supervisory role. He attributed the sharp rise in methadone-related deaths in Scotland, reported last year, partly to an increase in unsupervised consumption.

"We should be keeping control of it – avoiding leakage and having more say and control over what happens," Mr Notman told C+D. "We've lost our way on this and it's sad."