Prescription analgesics should not be a first choice for treating common ailments like back ache and arthritis, according to new federal guidelines designed to reshape how physicians prescribe medications like OxyContin and Vicodin.

Amid an epidemic of craving and abuse tied to these powerful opioids narcotics, the Centers for Disease Control and Prevention is exhorting primary care doctors to try physical therapy, exert and over-the-counter pain medications before turning to analgesics for chronic pain. Opioid drugs include medications like morphine and oxycodone as well as illegal drugs like heroin.

The new recommendations which physicians do not have to follow represent an effort to reverse virtually two decades of rising analgesic use, which public health officials blame for a more than four-fold increased number of overdose deaths tied to the medications. In 2014, U.S. doctors wrote virtually 200 million prescriptions for opioid analgesics, while deaths linked to the narcotics climbed to approximately 19,000 the highest number on record.

“We’re trying to chart a safer and more effective course for dealing with chronic pain, ” Dr. Tom Frieden, the CDC’s director, said in an interview with the Associated Press. “The risks of addiction and death are very well documented for these medications.”

More than 40 Americans die every day from painkiller overdoses, a staggering rate that Frieden said is “doctor driven.”

Under the new guidelines, doctors would prescribe analgesics merely after considering non-addictive pain relievers, behavioral changes and other options. The CDC also wants doctors to prescribe the lowest effective dosage possible. And physicians should only continue prescribing the narcotics if patients show significant improvement.

For short-term pain, the CDC recommends limiting opioids to three days of treatment, when possible.

The guidelines does not apply in respect of physicians who specialize in treating severe pain due to cancer and other debilitating diseases.

Though the guidelines are voluntary, they could be widely adopted by hospitals, insurers and nation and federal health systems.

Government officials have already tried multiple approaches to tackling analgesic abuse. The Food and Drug Administration limited some widely-prescribed analgesics to restriction refills. Nations like Florida and New York have cracked down on “pill mills” using databases to monitor what physicians are prescribing. And this week, Massachusetts signed into law a seven-day limit on first-time prescriptions for opioids the first of its kind in the nation.

“Changing medical practise isn’t rapid and it isn’t easy, ” Frieden said. “But we think the pendulum on pain management sway route too far towards the ready utilize of opioids.”

The CDC rarely advises physicians on how to prescribe drugs a role typically delegated to professional societies and drug regulators.

FDA labeling for the narcotics is broad, listing utilizes like “relief of moderate to severe pain.” Guidelines by ache experts provide more detail, but focus less on dangers. The CDC guidelines set such warnings upfront: “Opioids are not first-line therapy, ” states the agency’s first recommendation.

Local health authorities praised the CDC for weighing in on their own problems they face in their communities.

“The CDC is a respected source of information. Their guidelines carry weight, ” said Baltimore City Health Commissioner Dr. Leana Wen.

But some leading medical groups stopped short of embracing the recommendations. The American Medical Association, the largest professional group for physicians, cautioned that the guidelines could create problems if they steer patients toward ache treatments that aren’t accessible or covered by insurance.

“If they create unintended outcomes, we will need to mitigate them” said Dr. Patrice Harris, in a statement. “They are not the final word.”

In many ways, the guidelines are a return to older medical practice. Physicians trained in the 1960 s and 1970 s amid a wave of urban heroin use were learned how to reserve opioids for the most severe forms of pain, such as cancer or end-of-life care. That approach remains accepted.

But in 1990 s, some specialists argued that physicians were undertreating common forms of pain that could benefit from opioids, such as backaches and joint ache. The message was amplified by multimillion-dollar promotional campaigns for new, long-acting narcotics like OxyContin, which was promoted as less addictive.

OxyContin’s maker, Purdue Pharma, later agreed to plead guilty for misinforming the public about the drug’s risks.

“A whole generation of physicians grew up thinking they could use opiates fairly liberally, ” said Dr. Bruce Psaty, a prof at the University of Washington who also advises the FDA. “We are now in the process of re-educating ourselves and our patients.”

Physicians must now find a “comfortable balance, ” Psaty said, using opioids carefully while inducing sure patients don’t run untreated.

The CDC delayed its guidelines earlier this year following criticism from ache specialists, drugmakers and others.

Critics complained that the recommendations went too far and had mostly been developed behind closed doors by physicians who are biased against medication therapy. Instead of releasing the guidelines in January, as originally planned, the CDC agreed to re-open them to public input, receiving more than 4,000 remarks over a 30 -day period.

Critics said the proposal could block patient access to medications if adopted by health providers, insurers and hospitals. Such organizations often look to the federal government for health care policies.

Last week, an early sign of the guideline’s impact surfaced in the Senate. Lawmakers there overwhelmingly passed a bill designed to combat opioid abuse, including a provision involving the Veterans Administration to adopt the CDC recommendations.