Colt Brennan accidentally overdosed on a mixture of ethanol, methamphetamine, fentanyl and amphetamine during the fourth month of a six-month treatment program — a tragic ending becoming common among cases of drug-related overdoses.

Brennan, 37, died May 11 from “acute poly-drug intoxication” brought on by the “combined toxic effects of fentanyl, methamphetamine, amphetamine and ethanol,” according to the final autopsy and toxicology report issued by the Orange County Sheriff’s Department Coroner’s Division.

Among the greatest players in the history of University of Hawaii football, Brennan led the Warriors to an undefeated regular season in 2007 and was a finalist for the Heisman Trophy. Off the field, he battled post-traumatic stress disorder and traumatic brain injury from his playing career and a 2010 car collision, and also struggled with drug and alcohol addiction. Brennan’s family, at his direction, donated his brain and spinal cord to the Boston Clinical Brain Study Program to help further the understanding of the impacts of repeated brain trauma in athletes.

Brennan’s Warrior legacy will be celebrated at Saturday’s home game against New Mexico State at the Clarence T.C. Ching Complex.

Brennan’s relapse highlights the rise of fentanyl related deaths, particularly in individuals who unwittingly ingest counterfeit prescription pills that are a mix of methamphetamine and fentanyl. Honolulu police and agents with the U.S. Drug Enforcement Administration have seized more fentanyl this year than in all of 2020, and the DEA issued its first Public Safety Alert in six years last month, focusing on the dangers of counterfeit prescription pills containing fentanyl and methamphetamine.

Brennan’s father, Terry, has said someone gave his son a pain pill that was laced with fentanyl.

From 2011 through 2020, 80% of the 1,896 drug overdoses in Hawaii were coded as unintentional; 11%, suicides; and 8.5% were of an undetermined intent, according to Dan Galanis, epidemiologist with the state Department of Health’s Emergency Medical Services and Injury Prevention System Branch. The proportions were similar for the 621 deaths related to opioids spanning the same period: 80%, 11%, and 9%.

Alan Johnson, president and CEO of Hina Mauka, a residential substance abuse treatment organization, told the Star-Advertiser addiction is dangerous and bad things can happen regardless of all the support that a person could have — especially if they return to the street.

“We are not sure what happened in his (Brennan’s) particular situation,” Johnson said. He pointed out, though, that individuals who leave treatment are vulnerable to overdose trouble due to a dip in tolerance level. “We communicate that to people all the time, that if they leave treatment as well as abandon their support connections and relapse — that they need to be careful about overusing during the first relapse episode,” said Johnson. “Best to stay in treatment and talk honestly with your counselors and your support group about your struggles.”

Dr. Mark Baker, an emergency medicine physician at Pali Momi Medical Center and founder of End Meth, a nonprofit organization dedicated to doing away with methamphetamine use in Hawaii, said whether intentional or unintentional, drug- related overdose is always tragic. Opiate overdoses including heroin and fentanyl can cause sudden death. Less so with methamphetamine.

While single drugs can be dangerous, Baker said, mixing drugs compounds more than doubles the danger. “The combination of a stimulant like methamphetamine and an opiate like fentanyl can be deadly. There are users who feel like they need one to counter the other,” he said, adding, “It’s hard to understand why someone would want to counter danger with more danger.”

Further, Baker said, “There is no antidote for overdosing with methamphetamine or amphetamine. Naloxone is a very effective antidote for overdosing with an opiate like heroin,” or even for someone who takes too many opiate pills. Baker recommends calling Hawaii Cares for either a user or a family member who is in need of help.

Methamphetamine-­related deaths hit a 22-year high in Hawaii in 2020, with 192 deaths, up from 169 in 2019, according to the state Department of Health. Opioid deaths hit a four-year high last year, with 69, fatalities — up from 54 in 2019. Overdoses from heroin and synthetic opioids, like fentanyl, generally have increased since 2012. And over the past two years, deaths from fentanyl and synthetic opioids out numbered prescription opioids.

Dr. Jason Keifer, who leads Brain Health Hawaii, a Kahala clinic dedicated to neurological health, told the Star-Advertiser traumatic brain injuries caused by hits, falls, car crashes, drug use or low oxygen levels disrupts brain connectivity and sleep cycles, leading to discomfort and serious pain. Impairment in the frontal lobe, the region of the brain responsible for healthy decision-making, leads to increased risk of impulse-control issues, like substance use and other behavioral changes loved ones see in family members with TBI, Keifer said.

“In my experience, most people with a history of concussion are initially trying to find temporary relief from symptoms and pain. Unfortunately, the pursuit of short-term pain relief frequently cycles into a physiologic dependence and increased risk of overdose, depression and suicide,” said Keifer. “Elevating awareness will help others get help sooner than later. We are now able to treat more effectively with early intervention. Many can be helped and saved from the downward spiral.”

Hina Mauka provides care for multiple chronic conditions — both substance use disorders and mental health disorders, including issues that can range from psychosis to PTSD, anxiety and depression, said Johnson.

“We also address chronic physical health conditions such as heart disease, diabetes, some brain traumas, and more. For those with severe chronic conditions, this is so important. For the more severe and multiple conditions, if you treat one aspect without the other then a patient may be doing better with substance use disorders but be overwhelmed with bouts of depression,” Johnson said.