SOMBA K'E/YELLOWKNIFE - Even as the deadline for opting out of a Quebec class-action lawsuit approaches, the contraceptive injection Depo-Provera is still on NWT pharmacy shelves.

In 2004, Pfizer Inc. admitted that bone-mineral density loss is one of the potential side-effects of Depo-Provera. Pfizer has subsequently posted the following warning on their website:

"Depo-Provera CI use may decrease the amount of calcium in your bones. The longer you are on Depo-Provera CI the more calcium you may lose. This increases the risk of your bones weakening if you use Depo-Provera CI continuously for a long time (for more than two years). The loss of calcium may increase your risk of osteoporosis and broken bones, particularly after your menopause."

The $700 million lawsuit against the pharmaceutical company is based on Pfizer's failure to inform doctors or patients about the risks. Prior to 2004 the company promoted the injection as a safe product for use as a long-term contraceptive.

Depo-Provera was first approved for human use in 1992.

Despite the lawsuit, this product is still on pharmacy shelves, and still being prescribed to women who can then take it to their doctor who administers the injection.

Damien Healy, communications manager for the Department of Health and Social Services, said the product is still available because the department has yet to receive a warning from Health Canada that it is unsafe for use.

An official with Health Canada said the risks of use must outweigh the benefits in order to have a product removed from pharmacy shelves, but this is not the case yet.

"When used as directed ... the benefits of Depo-Provera are considered to outweigh the risks," Ashley Lemire, media relations officer for Health Canada, stated in an e-mail.

Lemire said Pfizer issued Health Canada-endorsed warnings about the product's possible effect on bone mineral density to health-care professionals and all Canadians in 2005. These warnings are also placed directly on the product's packaging.

Daryl Dolynny, president of the NWT Pharmacists Association, said there are many warnings on the product, adding calcium and vitamin D supplements are normally prescribed along with the contraceptive injection.

Non-insured health benefits may play a part in a person's choice to use the birth-control injection as some alternatives are not covered, according to Dolynny. He said even though the risks of using the product are discussed with users, some choose to use the injection anyway because they want the benefit of not having to remember to take oral birth control daily.

Dolynny said pharmacists provide as much information as possible, but if people have concerns, they should talk to their doctor. "We're just the conduit," he said.

According to Healy, in the NWT between 2008 and 2009 37 people made claims for the injection through supplementary and Metis health benefits. During that year, 88 separate claims for injections were made. He said these numbers do not include those who purchased the product without a benefits program, those who use non-insured health benefits through the federal government, or people who have employer-supplied health benefits like Green Shield, for which the government has no record.

After being administered, The Depo-Provera injection is effective for three months. A person wishing to use the contraceptive for a full year would need four injections annually.

Women who have experienced bone-mineral density loss as a result of using Depo-Provera are automatically included in the class-action lawsuit. Those who do not wish to be part of the suit must contact Quebec-based law firm Belleau Lapointe by May 31.