Government health officials on Tuesday provided strategies for primary care doctors who treat patients suffering from chronic pain. Among the recommendations: to use urine drug testing before prescribing highly addictive painkillers like oxycontin, codeine and morphine.

The guidance, put forth by the Centers for Disease Control and Prevention, is part of the government’s response to the epidemic of people dying from opioid overdoses, which include prescription painkillers but also the drug’s cheaper alternative, heroin. Data from the CDC show that in 2014 these deaths surpassed car accidents as the No. 1 cause of injury-related death.

For the most part, the CDC recommends limiting opioid prescriptions to people who have cancer, are receiving end-of-life or palliative care, or are suffering with serious illnesses. Primary care doctors have been in part responsible for the surge in addiction: Since 1999, the prescribing and sales of opioids has quadrupled, and primary care doctors account for nearly half of these prescriptions. 

“It’s important physicians understand any one of those prescriptions could end a patient’s life,” Dr. Tom Frieden, director of the CDC, said in a call with reporters Tuesday. 

Dr. Deborah Dowell, senior medical adviser at the Division of Unintentional Injury Prevention, part of CDC’s National Center for Injury Prevention and Control, said in the call that Tuesday’s guidance was not the first time the agency has recommended drug testing, though CDC surveys show physicians often do not do so.

A drug test would determine whether a patient is already taking opioids, but would not tell doctors how much of a drug is currently in a patient’s system, Dowell explained. If a test turns up negative for a patient who already has a prescription, it could indicate that the patient is selling the medication or giving it away;, while a positive test in a new patient could be a sign of “doctor shopping,” a term used to describe patients who seek multiple physicians to obtain large doses of medication.

“It’s a way to find out what level of opioids the patient might already be on,” Becky Vaughn, vice president of addictions at the National Council for Behavioral Health, who is familiar with the guidelines, said in an interview. “If someone already has a level of the drug when they come in to the doctor, then that obviously needs to be taken into account before a patient is given the medication.”

The CDC further recommended that doctors check prescription drug monitoring programs, a state-monitored database that helps doctors and pharmacists track patient medication histories. 

No clear treatment exists for pain management and often chronic can begin with acute pain from a car accident or surgery. Doctors, who want to help their patients manage the pain, often don’t understand that the prescription can have long-term, addictive effects, and may ultimately not deal with the source of the problem. Chronic pain is defined as pain lasting more than three months, and the CDC recommended that doctors try other treatments — such as prescribing ibuprophen, referring a patient to a physical therapist or using injection treatments — before prescribing opioids. If opioids are offered, the guidance reads, doctors should use the lowest possible effective dose for just three days in most cases, and occasionally seven days. “The risks are addiction and death, and the benefits are often transient and unproven,” Frieden said. “Beginning treatment with an opioid is a momentous decision, and it should only be done with full understanding by the doctor and the patient of risks involved.”