The only thing that I have read in my nursing studies about morphine is that once it travels into the digestive tract, you actually lose approximately 50-60%. This means that you actually only get about 40-50% of actual medication. I think that this theory is probably true of most oral pain medications. The best route for pain relief is through IM or IV administration. I don't know why doctors don't factor this into consideration when prescribing oral pain meds. I know that my husband got very little relief from the Avinza. The doctor now has him on 4mg Dilaudid 4 times/day and he is much better with this.