I take it with the 75mg Duragesic patch.
It depends on how long you have been on opioids & how big you are.
I am 6' 6" @ 270 lbs & have been taking opioids since 1993.
If you can use the patch & take less pills, you are saving your liver & life. Trans dermal patches are absorbed through your skin, this bypasses your liver.
Mixing these drugs can be fatal. I have OD'd 3 times ( all accidental, too many pills ) saved by paramedics. Actually I was saved by my wife, she noticed something was wrong and called 911.
I have no memory of more than a week of my life.
Tread carefully with these meds.