The head of the poison center serving Colorado and three other western states is retiring after almost 34 years, during which the facility’s staff quintupled and it expanded into drug tracking and research.
Dr. Richard Dart joined the in 1992, after working at a poison center in Tucson, Arizona. Since then, the Denver-based Rocky Mountain Poison and Drug Safety, which includes the poison center and related research, grew from about 30 employees to 150, added a surveillance system to monitor prescription drug misuse, and led a clinical trial that changed how hospitals treat venomous snake bites.
The center’s staff, who are employed by Denver Health, answer calls from Colorado, Montana, Nevada and Hawaii.
Dart and the Rocky Mountain Poison Center have been leaders in expanding how centers contributed to health care and public safety, and quite a few younger toxicologists and poison center directors were trained there, said Dr. Alan Woolf, a professor of pediatrics at Harvard Medical School who has worked with poison centers since the 1980s.
Dart’s tenure coincided with technological advances that allowed poison centers to respond more quickly and to better use their call data, Woolf said. Before personal computers, they had to rely on microfiche records of the thousands of products people could ingest and kept call records on paper, limiting the ability to do research, he said.
“I think Rick can be very proud of the role he played over the last 30 years,” he said.
While most people know poison centers as resources to call if their child swallows something potentially dangerous, they also train toxicologists and produce research on what substances Americans are ingesting, intentionally or not.
One of the Rocky Mountain Poison Center’s biggest accomplishments during Dart’s tenure was helping to pull off a clinical trial for a new rattlesnake antivenom, which became the preferred option in the early 2000s, he said.
Studying antivenoms is difficult because any given hospital will only see a few rattlesnake bites each year, which the poison center overcame by involving 15 medical centers and ensuring those hospitals’ emergency room doctors knew to randomize whether patients received only the old antivenom, or the new one in addition. They quickly realized patients getting the new one had better outcomes.
“You have to make sure that when that patient comes, you’re ready,” Dart said. “Luck favors those who are prepared.”
Dart also oversaw Denver Health’s acquisition of the or RADARS, which tracks misuse of prescription drugs with data from poison centers, reports from about 200 law enforcement agencies and surveys of the general public and people entering addiction treatment.
The U.S. Food and Drug Administration requires drugmakers to conduct studies about misuse of their products, and most contract with RADARS to do that work, Dart said.
Purdue Pharma, the now-bankrupt maker of OxyContin, created RADARS in 2001, then sold it to Denver Health for $100 cash and $10 million worth of reports.
with advocacy groups including Public Citizen and Physicians for Responsible Opioid Prescribing, as well as some individuals who lost family members to overdoses, urging the FDA not to work with RADARS.
Advocacy groups, including Public Citizen and Physicians for Responsible Opioid Prescribing, have alleged that RADARS is too close to drug companies and provides scientific cover for their products. But Dart maintains that the system is entirely independent.
RADARS offered an early warning about misuse and addiction from prescription opioids, especially generic forms of oxycodone, Dart said. Purdue became one of the main villains of the opioid epidemic in the public mind because of their unethical sales techniques, but most people misused cheaper generic versions, he said.
“While Purdue did some very inappropriate things and are getting their just deserts, I think, OxyContin wasn’t the problem,” he said. “OxyContin never had more than a few percent of the market.”
In general, the data RADARS collected from people seeking treatment showed price, availability and purity matter most to those who use illicit drugs, which foreshadowed the shift from prescription opioids to heroin and fentanyl following a government crackdown on pill mills, Dart said.
They haven’t yet been able to answer how many people would have preferred to keep using prescription pills, if not for the crackdown, and how many switched to heroin or fentanyl because they offered a stronger effect for the same price or less, he said.
“There was this demand, and people are going to fill it,” Dart said.
It also tracked the rise of polydrug use. About half of people who reported using one recreational drug also said they used others when Denver Health purchased RADARS in 2006, but now 80% to 90% take two or more drugs, Dart said.
That suggests people aren’t especially particular about seeking one experience, he said — they just want to feel something different than they would without drugs.
“State government, federal government, they focus on one drug at a time,” he said. People who use drugs “just go to something else.”
