THANK YOU!! That makes a lot of sense, and now I understand much more! However, now I am concerned that since I do have such a high tolerance if that is enough for me. Maybe that is why I feel I need a better BT med. You say that it is b/c of taken orally, it goes through the gi...etc...My brothers friend (who takes for recreational purposes unfortunately) does not take it orally and does what you SHOULD NEVER do with them (crush) and I think that is why he believes it is so strong and why he wonders why it doesnt work well for me when I take them like you are supposed to. So, I think your clarification really helps. I wonder then if I should have the Opana changed to 40 and keep my BT the same, except for the fact I dont like the additional apap. I just dont think I need additional tylenol.