A QCL may include a substrate, and a sequence of semiconductor epitaxial layers adjacent the substrate and defining an active region, an injector region adjacent the active region, and a waveguide optically coupled to the active region. The active region may include stages, each stage having an upper laser level and a lower laser level defining respective first and second wave functions. The upper laser level may have an upper laser level average coordinate, and the lower laser level may have a lower laser level average coordinate. The upper laser level average coordinate and the lower laser level average coordinate may have spacing of less than 10 nm. Wave functions for all active region energy levels located below the lower laser level may have greater than 10% overlap with the injector region.