What if Patients Aren't Lying? A Quantum Cognition-Informed Approach to Interpreting Clinical Variability in Correctional Opioid Use Disorder Assessment

Opioid use disorder (OUD) is highly prevalent in correctional settings, where assessment occurs under conditions of stress, surveillance, and timeconstraint. Under these conditions, fluctuating or inconsistent self-report is common and is frequently interpreted as deception, with consequences for documentation, treatment access, and patient safety. This article develops a conceptual framework for interpreting such response variability without presuming intentional dishonesty, and operationalizes it into a structured interpretive tool for real-time clinical use. The framework draws on three literatures: correctional health and OUD assessment, forensic work on malingering, and quantum cognition research on judgment under uncertainty. Constructs from this synthesis were mapped to recurring patterns observed in correctional OUD assessment. Four quantum cognition constructs (order effects, contextuality, superposition, and interference) account for commonly observed patterns, including environment-dependent disclosure, shifts in withdrawal reporting, and ambivalence toward opioid agonist therapy (OAT). These constructs are translated into a structured interpretive tool that prompts clinicians to consider nondeceptive mechanisms (order, context, motivation, and emotional state) before attributing variability to malingering. Applied at the point of care, the framework supports safer withdrawal management, clearer documentation, and more equitable OAT access in correctional environments.