OMAHA, Neb. (AP) — Blue Cross Blue Shield of Nebraska has adopted federal guidelines on avoiding opioids as painkillers.

The guidelines were released in March 2016 by the Centers for Disease Control and Prevention and include avoiding opioids as the first or second painkiller option.

The Nebraska insurer’s chief medical officer, Dr. Debra Esser, said opioid alternatives include nonsteroidal anti-inflammatory drugs and physical therapy and chiropractic treatments.

Guidance from the Nebraska Medical Association and Nebraska Department of Health and Human Services also mirrors the federal guidelines.