I would not assume that an increased requirement for these types of medication until and unless the prescribing physician genetic testing on the patient to test any possible definciencies in metabolizing medications.
It is an easy thing to do; even only uses saliva instead of a blood draw in most cases.
There's an ER doc in a hospital who, the moment she sees a recent rx for Norco in the system, refuses to prescribe anything more than tramadol.
There's a patient with recurrent miscarriage (seven in less than a year and a half, including 2 tubals terminated with methatrexate), and a lot of pain issues.
Her genetic testing results tell us that codeine and tramadol need to be avoided, where fentanyl, hydrocone, morphine, and oxycodone help some, but aren't ideal. The opiods with the least genetic impact based on the report include butorphanol, hydromorphone, meperidine, methadone, oxymorphone, and tapentadol.
This doctor has given her such a hard time about the hydtocodone, that she's scared to go to the ER because she's afraid of being treated like an addict, even with solid evidence in her corner. With her medical state, trying for a pregnancy with long history and high risk for ectopic pregnancy, this is more dangerous than denying the script when miscarriage is an easy diagnosis and genetic testing is even easier to accomplish.
