Decreasing Provider Hesitancy to Initiate Suboxone Therapy for the Unhoused: A Quality Improvement Project

Abstract

Background: Opioid use disorder (OUD) remains a critical public health challenge in Arizona and across the United States (US), disproportionately affecting unhoused populations who face barriers to consistent and effective treatment. Despite the efficacy of medication-assisted treatment (MAT) with buprenorphine (Suboxone), provider hesitancy—driven by stigma, limited confidence, and concerns about treatment adherence—continues to impede access to care. Purpose: The purpose of this quality improvement (QI) project was to decrease provider hesitancy to initiate Suboxone therapy for unhoused individuals through the delivery of a brief, targeted educational intervention and post-intervention survey. Methods: A short educational video was developed by the Project Lead to address common provider concerns, reduce stigma, and highlight evidence-based benefits of MAT for unhoused patients. Providers were invited to view the video and complete a post-survey immediately, assessing changes in their knowledge, attitudes, and willingness to initiate Suboxone therapy—the Plan-Do-Study-Act (PDSA) framework guided project design and implementation. Results: Survey responses indicated improvements in provider-reported knowledge and comfort levels regarding MAT initiation for unhoused populations. Respondents demonstrated increased willingness to consider prescribing Suboxone following the educational intervention. Although limited by a small sample size, single-site implementation, and reliance on self-reported data, the project's findings suggest that even brief, targeted education can have a positive influence on provider attitudes. Conclusions: This project supports the value of focused educational interventions in addressing provider hesitancy to initiate Suboxone therapy. Implications for future practice include expanding similar training across multiple sites, integrating content into continuing education programs, and conducting longitudinal assessments to evaluate the sustained changes in prescribing behaviors. By equipping providers with the confidence and knowledge to initiate MAT, healthcare systems can expand access to life-saving treatment and reduce disparities among unhoused individuals with OUD.