The greatest quarterback in University of Hawaii history reportedly died from a fatal mixture of alcohol and fentanyl after years of struggling with addiction and traumatic brain injury, a lethal combination of ailments that physicians are working to address in football players and others who have suffered serious blows to the head.

According to police in Costa Mesa, Calif., and the Orange County Sheriff Coroner’s office, Colton “Colt” J. Brennan, 37, was pronounced dead at 12:03 a.m. May 11 at Hoag Memorial Hospital Presbyterian in Newport Beach. He was in the fifth month of a six-month treatment program, according to his father, Terry Brennan, who said someone gave his son a pain pill that was cut with fentanyl, a powerful opioid.

The Costa Mesa Police Department is not investigating his drug overdose, according to a spokeswoman.

Alcohol and drug abuse is a common problem among people who have sustained traumatic brain injury, according to the National Institutes of Health, as patients seek ways to ease physical pain, relieve anxiety and get regular sleep. Those who self-medicate in such a manner are at greater risk of an overdose.

In 2019, there were 6,198 drug overdose deaths in California, the highest total in four years. In Honolulu, drug overdose deaths hit a five-year high last year, with 197.

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A 2017 Boston University School of Medicine study found chronic traumatic encephalopathy (CTE) — brain degeneration likely caused by repeated head trauma — in 99% of brains donated by National Football League players for post-mortem study, and in 91% of college football players and 21% of high school football players.

Recognizing the signs of brain injury and getting help before it leads to substance abuse is key to keeping patients healthy and alive, experts say.

According to Brain Health Hawaii, a Kahala clinic led by Dr. Jason R. Keifer, symptoms of brain injury or concussion may seem mild or go unnoticed at first, but may appear later and worsen over time.

Following a concussion, about 15% to 20% of patients experience symptoms that linger for a year or longer, negatively affecting memory, attention and sleep. People with brain trauma may appear dazed and disoriented, with slowed speech, poor balance and glassy eyes. If ignored further, the injury may lead to chronic headaches, depression and anxiety.

“The brain is a 3-pound organ with Jello-like consistency floating around the skull protected by a fluid that acts like a shock absorber. You can suffer a concussion or a (traumatic brain injury) even if you don’t black out,” Keifer said. “These subconcussive hits are stunning to the neurons and stunning to the brain. It’s going to set the brain up for being at a chronic low threshold for future concussions.

“The brain is a complicated, sophisticated, sensitive organ and it needs sleep, and if it’s not getting sleep then everything starts to unravel,” he said. “Those people who have mood issues and are trying to calm down, or their sleep disturbance is too much, at some point if it’s not getting better, you are going to see people reach for a prescription, pain pills, things that are not prescription, like alcohol. If you are already using those substances, that’s where you are likely to go to find symptomatic relief.”

That appears to be how Brennan chose to deal with his pain.

Terry Brennan told the Southern California News Group that just two days before his son’s death, on May 9, the family had returned from a trip to find the younger Brennan “extremely intoxicated” at their Orange County home. He took him to a hospital detox facility but it was full, and Colt was released without his family’s knowledge.

“He just spent one too many times on the dark side of life, and it caught up with him,” Terry Brennan told the Orange County Register.

Seasons of struggle

With his arsenal of arm angles, moxie and a million-megawatt smile, Brennan led Hawaii to an undefeated regular season in 2007, bringing fame and national prominence to the program.

The Heisman Trophy finalist was an easy-going, generous guy who always had time to help others, especially kids, according to his friends and coaches. Brennan also felt a deep responsibility to give back to the state that had given him and teammates like him who were junior college transfers a chance to be great.

But after leaving UH following his senior year, Brennan had a short-lived NFL career.

In an interview in June with Wade Hampton Peery, host of The Flow Theory Podcast, Brennan said he used cannabis before games to ease his anxiety and help him focus.

“This is something that started in junior college. I’d go to my pregame meal, then I’d go to my (hotel) balcony and roll a blunt, and I’d smoke a fat blunt before the game, both in junior college, in NFL and in college. Then I would take a shower, brush my teeth, get clothed up and then get on the bus to the game and I would be in the zone right there … . Every time you come out of the tunnel it’s like someone puts a needle of adrenaline in your arm. You ain’t high no more, you are just ready to play the game. And so it would take away all that pre-game anxiety. All my team knew it. I don’t know if my coaches did or not but it was just something that I did,” he told Peery.

On Nov. 19, 2010, Brennan was involved in a car crash on Hawaii island just days after the then-Oakland Raiders contacted his agent and indicated they wanted to bring him back, according to Brennan.

He was a passenger in a 1997 Toyota SUV operated by his then-girlfriend, Shakti Stream, heading north on Queen Kaahumanu Highway near Kekaha Kai State Park, when their vehicle crossed the center line and collided head-on with a southbound 1996 Saab sedan, according to Hawaii County police.

Stream and Brennan, who were both 27 at the time, were transported to Kona Community Hospital in serious condition. Brennan was later flown to The Queen’s Medical Center for surgery. The driver of the Saab sedan, a 47-year-old Waikoloa woman, was taken to North Hawaii Community Hospital in serious condition.

Stream did not respond to Honolulu Star-Advertiser requests for comment for this story.

Discussing the collision on Peery’s podcast, Brennan said he and Stream had finished a morning yoga class and stopped at an organic grocery store for some eggs while on their way to the Mauna Lani Resort to play beach volleyball. Stream drove so Brennan could eat, and he watched a video on her phone. She looked down to see it, he said, and crossed the center line.

“We went head-on at like 50 miles an hour. I spent nine days in a coma. I woke up with a broken clavicle, I broke all my ribs on my left side, I broke my eye socket … . When the car flipped, I hit my head against the frame and developed six hematoma in my brain. I ended up developing traumatic brain injury,” he told Peery.

Brennan tried to battle back from his injuries and return to pro football in 2013 with the Arena Football League, but could not get a medical clearance. He told the Honolulu Star-Advertiser in 2014 he had gotten a diagnosis he was suffering from traumatic brain injury.

Speaking to Peery, he said it was “really sad” how his playing career ended.

“Football is no longer an option. You can’t play it if you want to live a happy and healthy life. It was a hard pill to swallow. I’ve just been trying to move on ever since,” he said.

Moving on was the hard part, and Brennan began a struggle that countless former college and professional athletes have faced: how to define a life lived for the game while healing from mental and physical wounds.

His troubles continued, with several run-ins with law enforcement on Oahu and Hawaii island for various offenses, including operating a vehicle under the influence of an intoxicant, speeding, driving without proof of insurance, criminal trespassing and disorderly conduct.

In Kona, Brennan was arrested for separate incidents in August and November at the Kona Seaside Hotel and his Kailua-Kona home, where police arriving at the scene described him as “extremely intoxicated and uncooperative” and “heavily intoxicated.”

In an April 12 Instagram post, just a month before his death, Brennan recounted some of his hardships:

“I captured every dream I had as a child. I was drafted into the league only to have 2 knee and 2 hip surgeries. I reached my 3rd year in the NFL, only to awake from a coma with traumatic brain injury as a passenger in a car accident. I battled drug and alcohol abuse, and eventually developed blood clots years after the car accident. I spent 9 months in the hospital and for the last 2-1/2 years have been trying to learn how to walk again with a broken heart. I found redemption once, I will find it again.”

‘His heart was here’

Many of Brennan’s friends, family members and former teammates tried to get him to undergo treatment for traumatic brain injury. They also urged him to continue fighting to overcome the desire to drink and use illegal drugs and to try different programs until he found one that worked.

Honolulu City Councilman Augie Tulba, a close friend of Brennan’s, posted an homage to the former quarterback on the day of his death that included a photo of the pair on a boat off the Kona Coast, a fresh-caught mahimahi hoisted high in the background by the boat’s captain.

Brennan and Tulba were all smiles, a great memory from happier times, Tulba said.

“My conversations with him was never, ever about football. He would call me out of the blue to talk story about stuff,” Tulba said. “Everybody knows he had demons, but that’s your friend no matter what. I just wanted to be a friend, that when he called, either I was going to be ready (to help) or he was going to give me good news, that’s the kind of friend you like be.”

Tulba, who watched his brother battle addiction before taking his own life, said he and Brennan’s many good friends tried to get him help and onto a positive path. Brennan wanted to try holistic healing and drug rehabilitation but never ended up making the meetings, he said.

“That lifestyle, when you are at a certain level where you cannot go wrong, you get out of situations easy, you almost feel like you cannot die, and I think that’s how he thought,” Tulba said.

A signed picture of Brennan in a UH uniform adorns a spot above the desk of Bruce “Rollo” Rollinson, head coach of the Mater Dei Monarchs high school football team in Santa Ana, Calif., where Brennan starred after backing up Heisman Trophy winner and University of Southern California star Matt Leinart.

Rollinson said Brennan was a leader on the field who never took himself too seriously.

“Even then I knew he was smart, but you knew there was a little bit of a maturing process; he was a fun-loving, goofy kid,” he said. “But he had a golden arm.”

Rollinson said he knew Brennan was at an Orange County rehabilitation center the last few months before he died and working hard to get sober.

“What I preach is, cherish the memories and try to celebrate and don’t ask why. But everyone is asking why and I don’t have the answer to that,” he said. “My eyes kept wandering to that picture — 37 years old, you gotta be kidding me. It’s been tough.”

Rollinson said that about six or seven years ago, he walked into the Mater Dei football offices and saw a figure with a cane struggling down the hallway.

“I thought, “Who in the hell is this?’ and then he got closer and, ‘Oh, god, it’s Colt’,” he said. “I didn’t see a dramatic amount of improvement. I’d see that big smile again. … He was a beat slower, but, oh boy, you could still see the sparkle in his eye. He still had that million-dollar smile.”

Honolulu attorney Michael Jay Green represented Brennan during several of his criminal cases. He said Brennan had too many friends who just wanted to be around the football star and did not look out for his interests, enabling bad behavior instead.

One group would show up Sundays at Brennan’s Kaaawa home during the football season with beer and whatever else he wanted.

“His heart was here and his heart was broken. We spent a lot of time talking just about things. That smile, I’d see his eyes light up and that smile. He did not have a sense of arrogance, not a sense,” Green said.

“You would think he was 57 with all the things he went through. He changed the image of Hawaii as a national power. Then he wound up crying in a courtroom with me for what he had done. Once he gave up his belief that he could play again, then what was left for him?”

Green recalled that during one of Brennan’s first court appearances, the judge asked the attorneys handling the case to approach the bench. The judge told Green and the prosecutor he never missed a UH football game and that if they wanted him to recuse himself, he would.

“‘That’s OK judge,’ the prosecutor tells the judge,” Green said. “‘He’s one of my favorite players also.’”

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Get help

At Brain Health Hawaii in Kahala, Dr. Jason R. Keifer employs a noninvasive, nonpharmaceutical approach to restoring normal brain wave activity and connection in those who have suffered concussions or other traumatic brain injuries. Staying off the field or out of work for a proper period of time while getting at least nine hours of sleep and staying hydrated is essential to the healing process, he said.

Dr. Jennifer King, who works in pediatric and adolescent sports medicine with Hawaii Pacific Health, emphasized good hydration and hygiene, getting a proper amount of sleep and managing stress as key to maintaining brain health. With the return of football and contact sports for kids after nearly two years, King urges parents and coaches to ensure young athletes are properly prepared before going full speed on the field.

“As they train up, they will return to their former processing time and reaction speed, and that keeps them uninjured,” she said. “Focus on the conditioning and the training before they even get into a position where they are doing contact.”

For more information

>> Contact the Hawaii Concussion Awareness Management Program at the University of Hawaii at Manoa via email at info@hawaiiconcussion.com or visit hawaiiconcussion.com

>> Find Brain Health Hawaii at 4211 Waialae Ave, Suite 203; for appointments, call 554-5688 or check brainhealthhawaii.com.