With horrified family members crying out in anguish, a Brooklyn man and his adult son died together of a double opioid overdose while celebrating a family birthday party Sunday, police said. 
 
 Joseph Andrade, 44, and his 22-year-old son, Carlos, lost their lives soon after excusing themselves from the festivities by telling people they were going for a smoke. 
 
 For some reason, the younger man, who was not known to use drugs, joined his father, a reputed addict, in taking some powerful opiates — apparently snorting a mix of heroin and fentanyl, police sources said. 
 
 Carlos — his face turning purple as he asphyxiated — was discovered by his girlfriend, Jasmin Santos, just inside the foyer of his father’s building just after 3 a.m. 
 
 “Jasmin found Carlos dying,” a cousin, Sonia Santos, told The Post. “She screamed and tried to help him. She said he was turning blue.” 
 
 Joseph was found feet away, outside the building on 27th Street near Fourth Avenue in Greenwood, according to cops. 
 
 The distraught women called 911 and responding officers administered Narcan, a drug that reverses the effects of an overdose. But it was too late, and both men died at Lutheran Medical, authorities said. 
 
 Carlos had driven up from Maryland for the birthday bash with Jasmin and their children, ages 1 and 4, a relative said. 
 
 “He was very close with his oldest son,” Santos said of Carlos. “I don’t know what they are going to do without him.” 
 
 Acquaintances said Joseph, who worked on and off as a mechanic, may have struggled with addiction. 
 
 “The father had a problem,” said a neighbor who asked that their name be withheld. “People knew. I was surprised Carlos was involved. He was a good son.” 
 
 “That building was always fine until recently,” another resident lamented. “We’ve never had anything like this before, but lately there’s been a lot of men, drinking, getting drunk outside, late into the night.” 
 
 The father and son’s deaths are under investigation and the cause will be determined by the medical examiner, officials said. A projected total of 1,300 people are believed to have succumbed to drugs in 2016, officials have said. 
 
 Additional reporting by Emily Saul ||||| Law enforcement agencies nationwide are struggling to stop a growing heroin epidemic from spreading across the United States. (McKenna Ewen, Whitney Shefte/The Washington Post) 
 
 Midwest health officials worried this would happen. 
 
 It’s why they brought together a tri-state coalition — Ohio, Indiana and Kentucky — to talk about the dangers, and it’s why they issued a stern, desperate warning last month to first responders and addiction counselors who patrol the front lines of the opioid war every day. 
 
 They said the situation was “dire.” One Ohio coroner told users they were “literally gambling” with their lives. 
 
 But their public plea could not prevent the heroin on their streets from being cut and sold with a new opioid analog 100 times more potent than fentanyl and 10,000 stronger than morphine. 
 
 In chemical terms, it’s called carfentanil. Colloquially, it’s an elephant tranquilizer. 
 
 It’s the most potent opioid used commercially, strong enough to knock out — or even kill — a 15,000-pound pachyderm, and used primarily to sedate other large animals, like ox, moose and buffalo. 
 
 [A new front in the opioid war: Elephant tranquilizer] 
 
 Now drug dealers, in an attempt to stretch their supply and deliver a stronger, longer high, are cutting their heroin with carfentanil — which is far more dangerous than its already troublesome but less potent cousin, fentanyl. 
 
 And in a 48-hour window this week, two counties near the Ohio-Indiana border may have been hit with a dangerous wave of it. 
 
 On Tuesday night, officers responded to at least 11 overdose cases in Jennings County, Ind. That same day and into Wednesday evening, authorities in Hamilton County, Ohio — home to Cincinnati — received more than 50 heroin overdose calls, reported TV station WCPO. 
 
 In Ohio, the calls took first responders all over the city: a United Dairy Farmers bathroom, a McDonald’s, the scene of a car crash and a Rally’s parking lot. 
 
 The man at Rally’s died, according to WCPO. 
 
 Just last weekend, only days before the 48-hour frenzy of calls, about 30 other overdoses were reported in Hamilton County, Newtown Police Chief Tom Synan told Fox 19. 
 
 Officers responding to numerous overdoses this evening in Jennings Co. 11 patients so far. #Narcan in high demand. pic.twitter.com/LMwhWPAaOo — Sgt. Stephen Wheeles (@ISPVersailles) August 24, 2016 
 
 Authorities have been careful not to speculate whether the overdoses across the two states are connected, or whether they all came from one particularly potent batch of heroin, but police told WCPO that is likely the case. It may have been mixed with fentanyl, carfentanil or even rat poison — making it that much harder to treat overdose patients. 
 
 That was a crucial part of the public health warning Hamilton County released last month. 
 
 “Take this as a dire warning to all, if you choose to purchase and use any forms of heroin,” Hamilton County Coroner Lakshmi K. Sammarco said. “No one knows what other drugs may be mixed in or substituted and you may be literally gambling with your life. 
 
 “Don’t count on Narcan to be able to reverse the effects of carfentanil.” 
 
 
 
 A box of the opioid antidote Naxolone, also known as Narcan, sits on display during a family addiction support group on March 23 in Groton, Conn. (John Moore/Getty Images) 
 
 Narcan is an FDA-approved nasal spray version of naloxone, a life-saving medication that can reverse the lethal effects of an opioid overdose. It was approved in November 2015 and has been credited with saving countless lives. Across the country, first responders are stocking up on Narcan and some agencies have even started training civilians on how to use it on each other. 
 
 Usually, one, maybe two, doses of Narcan will sufficiently help someone overdosing on pure heroin. 
 
 But when the drug is cut with other substances, especially carfentanil, it can take as much as a half dozen doses, maybe more. Complicating matters is that law enforcement officers have no way of knowing on scene what kind of heroin cocktail the user has injected. Fentanyl and carfentanil are mixed into the heroin in nearly untraceable doses. Both are colorless and odorless. 
 
 Often, users don’t even know until it’s too late. 
 
 “It’s not like they hand you your dope and say, ‘Here’s the carfentanil dope,’” Jessica Sageser, a former heroin user, told WCPO. “You don’t know. The seriousness of it has escalated so much more because this drug is, like, indescribable. It’s a snap of the fingers and the blink of an eye, and you are done.” 
 
 [‘To my daughter’s drug dealer’: A distraught mother’s viral Facebook post] 
 
 Carfentanil is not just dangerous to users, according to an Aug. 12 Washington Post story: 
 
 Veterinarians who handle the drug wear protective gloves, aprons and masks, treating it “almost like uranium,” in the words of one zoo veterinarian who spoke to Fusion. A dose the size of a grain of salt could kill a person, and carfentanil can even be lethal when absorbed through the skin, according to the Drug Enforcement Administration. 
 
 The DEA has warned narcotics officers, reported the Cincinnati Enquirer, and Ohio Attorney General Mike DeWine has urged police in his state to stop field testing for fear that handling the substances without proper precautions could be too dangerous. 
 
 “It’s just too high of a risk,” DeWine said, according to the Columbus Dispatch. “This stuff is just now hitting. You’re really not seeing [police] departments with any experience with it at all.” 
 
 
 
 A man injects himself with heroin using a needle obtained from the People’s Harm Reduction Alliance, the nation’s largest needle-exchange program, in Seattle in April 2015. (David Ryder/Reuters) 
 
 Earlier this month, prosecutors in Pennsylvania issued a warning on carfentanil, which may be responsible for some of the 200 recent overdoses in the area — 20 of them fatal. 
 
 It also has been linked to overdoses this year in Kentucky and Florida. 
 
 Last week, police in Huntington, W. Va., responded to 26 heroin overdoses in a span of four hours. 
 
 [The latest overdose outbreak shows just how dangerous the heroin epidemic has gotten] 
 
 The Hamilton County Heroin Coalition, which works with law enforcement officials in southeast Indiana and northern Kentucky, is still investigating the widespread spat of overdoses this week. 
 
 “I’ve got to say to whoever pushed this out on the street,” Synan told WCPO, “this was the wrong thing to do.” 
 
 More from Morning Mix: 
 
 Texas law now permits guns in college classrooms. Protesters came armed with sex toys instead. 
 
 World’s largest aircraft takes world’s slowest nosedive during second test flight 
 
 Federal judge: Starbucks is not ripping you off when it puts lots of ice in your iced tea ||||| They died in restaurants, theaters, libraries, convenience stores, parks, cars, on the streets and at home. 
 
 At least 4,149 Ohioans died from unintentional drug overdoses in 2016, a 36 percent leap from just the previous year, when Ohio had by far the most overdose deaths in the nation, according to figures compiled by The Dispatch from county coroners. 
 
 And the grim toll is getting worse: Many coroners said that 2017's overdose fatalities are outpacing 2016's. 
 
 Last year's total smashed the record of 3,050 set in 2015. An average of 11 people died each day in 2016 from heroin, fentanyl, carfentanil or other drugs. 
 
 The new number was obtained by The Dispatch by contacting the coroner's offices in all 88 counties. The Ohio Department of Health collects overdose data to release annually in August, but given the growing drug crisis in Ohio, and the General Assembly's ongoing debate on the state's two-year budget — including more than $170 million added by the Ohio House to battle the drug epidemic — updated numbers are particularly important now. 
 
 Ohio's final 2016 total will be even higher because not all coroners have completed their overdose tally, and coroners in six smaller counties (representing 1.8 percent of Ohio's population) did not respond to the newspaper's repeated requests for 2016 totals. 
 
 >> Strapped for funds, Ohio coroners likely undercounting opioid epidemic 
 
 The rapid rise in drug deaths is most pronounced in large urban counties such as Cuyahoga, where the 666 deaths easily led the state in 2016. The others are Franklin, Hamilton, Lucas, Montgomery and Summit. In one year, the overdose-death count in Ohio's six biggest counties doubled. 
 
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 The 2016 numbers raised the state's death toll from drugs to 17,000 since 2003. The devastation is evident statewide, in big cities and small towns, urban and rural counties, rich and poor areas. 
 
 Dr. Lisa Deranek, the Medina County coroner and an emergency-department physician, is dealing with multiple deaths a week from opioid overdoses as head of the coroner's office while also treating overdoses in the emergency department. Sometimes she has revived the same person several times a week. 
 
 Deranek said she and others on the front lines are exhausted. 
 
 “It’s a growing, breathing animal, this epidemic,” she said. 
 
 While heroin continues its role as a killer, coroners' 2016 autopsy reports show that fentanyl, a synthetic opiate 50 times more powerful than morphine, and carfentanil, an animal tranquilizer so strong that an amount the size of a grain of salt can be deadly, have flooded Ohio and are largely to blame for the spike in deaths. 
 
 Last week, Dr. Thomas P. Gilson, Cuyahoga County's medical examiner, told a U.S. Senate committee studying ways to combat illicit drugs, "The opiate crisis is a slow-moving mass-fatality event that occurred last year, is occurring again this year and will occur again next year." 
 
 Cuyahoga County recorded 400 fentanyl-related deaths between Nov. 21, 2015, and Dec. 31, 2016, more than double the fentanyl-related deaths of all previous years combined. Gilson's office is projecting nearly 600 this year. 
 
 Those in the county who are addicted to drugs would fill the stadium where the Cleveland Browns play (capacity 73,000-plus), while those who switch to fentanyl each year would fill the Cleveland Cavaliers' arena (20,000-plus). 
 
 Even worse, Gilson said the opioid crisis, which has affected mostly white drug users, is moving into minority communities. 
 
 "With seemingly purposeful intent, cocaine is now being mixed into the fentanyl distribution and the analogs of fentanyl in an effort to introduce these drugs into the African American population," Gilson said. 
 
 "Cocaine had been the only drug that victims were predominately African American. The covert introduction of fentanyl into the cocaine supply has caused a rapid rise in fatalities, and in 2017, the rate of African American fentanyl-related deaths has doubled from 2016.” 
 
 In much smaller Allen County in northwestern Ohio, Coroner Gary R. Beasley said drug users are gambling with their lives. Allen County, which includes Lima, saw overdose deaths more than double to 36 in 2016 from 15 in 2015. All involved fentanyl: 14 people died from fentanyl alone and 22 from a mixture of heroin, fentanyl and other drugs. 
 
 “People don’t know what they are buying,” Beasley said. “It’s deadly.” 
 
 Powerful testimony from Newtown, #Ohio Police Chief Synan on how the #opioidcrisis has impacted his community: pic.twitter.com/dk7OZaBfYp 
 
 — Rob Portman (@senrobportman) May 25, 2017////////////////// 
 
 Gary Guenther of the Summit County medical examiner's office said that of 308 deaths there in 2016, nearly half involved carfentanil. As soon as word hit the streets about the new lethal drug, "people wanted to get it," he said. "It doesn't make any sense." 
 
 Information from Franklin County Coroner Dr. Anahi Ortiz was difficult to obtain. Appointed coroner in 2014 and elected last year, Ortiz has not released full overdose statistics for 2016. She has mentioned some numbers in public appearances, but she would not release that information to The Dispatch. 
 
 Ohio's overdose-death toll would have been an estimated 2,300 higher in 2015 if not for lives saved with naloxone, an antidote for opioid overdoses, according to the state Department of Mental Health & Addiction Services. Emergency responders, other drug users, family members and friends have administered naloxone thousands of times to revive dying people. The state legislature acted to make naloxone available at pharmacies without a prescription. 
 
 The 2016 total for those revived by naloxone is not yet available but is expected to be higher. 
 
 Ohio, which narrowly topped the nation in drug-overdose deaths in 2014, held the unenviable No. 1 position again in 2015 — 800 deaths ahead of second-place New York, according to a Kaiser Family Foundation analysis using statistics from the U.S. Centers for Disease Control and Prevention. Totals for all states for 2016 are not yet available. 
 
 William Denihan, who is retiring after 15 years as head of the Alcohol, Drug Addiction & Mental Health Services Board of Cuyahoga County, said he has mixed feelings about leaving with the drug epidemic "so out of control. I call it a tsunami. To leave at this point is distressing." 
 
 "We've done so much, but the numbers are going the other way. I don't see the improvement." 
 
 Denihan said he spoke at the Cleveland Clinic at a meeting of doctors and nurses. "I asked for a show of hands of people who had lost a loved one or knew someone who had lost someone to a drug overdose. Almost every hand raised." 
 
 “We’ve never seen anything like this. The drugs keep getting more potent,” said Cheri L. Walter, chief executive officer of the Ohio Association of County Behavioral Health Authorities. “People can recover; they just need to get into treatment.” 
 
 Walter recommends extending drug-prevention and -education efforts beyond schoolchildren to young and middle-age adults because they make up the bulk of those who are dying. 
 
 Gov. John Kasich's administration has taken a number of steps to stem the tide of opioid deaths, most recently approving $20 million for drug-research technology. The administration allocated nearly $1 billion a year, much of it included in Medicaid health-coverage expansion, to cover treatment for low-income addicts. That total was not increased in Kasich's proposed two-year budget; the state's fiscal year begins July 1. 
 
 The Ohio House added $170 million to Kasich's proposal to fight the epidemic, mostly through prevention and treatment. The Senate is considering the budget. 
 
 Ohio was a national pioneer in cracking down on "pill mills" issuing prescription painkillers such as OxyContin, but health officials say the move sent addicts to stronger drugs such as heroin. 
 
 Dr. Mark Hurst, who is serving a dual role as medical director at both the state mental health and health departments, said the death toll is rising because "the migration has continued to more-potent drugs." 
 
 Although naloxone has kept the death toll from climbing even higher, Hurst added a caution: "It's a treatment for overdoses, but it doesn't cure addiction. 
 
 "This is going to turn around. I wish I could tell you when it's going to turn around." 
 
 Dispatch reporters Randy Ludlow and Kimball Perry contributed to this story. 
 
 ajohnson@dispatch.com 
 
 @ohioaj 
 
 ccandisky@dispatch.com 
 
 @ccandisky
– Tragedy struck a Brooklyn family over the weekend when a father and son died of drug overdoses at a birthday party. Police say Joseph Andrade, 44, and his son Carlos, 22, told family members they were stepping outside for a cigarette when in actuality they were going to snort a mix of heroin and fentanyl, an opioid 50 times stronger than morphine, the New York Post reports. Carlos, who had driven up to Brooklyn from Maryland, was discovered by his girlfriend, Jasmine Santos, as he asphyxiated in the foyer of his father's building around 3am. Joseph was found outside the building on 27th Street. Emergency responders administered Narcan, a medication that blocks the effects of opioids, to the two men and took them to NYU Langone Hospital, but they died within an hour of being found, the New York Daily News reports. Joseph Andrade is a reputed addict but several witnesses expressed surprise at his son's involvement. “I’m so surprised because I know Carlos, and I never know that he used drugs or anything like that," Jasmine Santos' uncle Yovanny said. New York City officials say 1300 people died from overdoses last year, 90 percent of which were caused by heroin or fentanyl.