An uptick in marijuana use is changing the way doctors handle office visits.

Dr. Robert John of Troy Oral Surgery noticed an increase of patients who arrive for procedures already under the influence.

“It is very prevalent right now,” John said. “People actually smoke in the car and come in. We’re not confrontational, right? You have to handle things in a very non-judgmental way.”

And John says it causes other issues. The patients, for example, don’t make the best decisions and it may actually make them more anxious.

John says potential strains of marijuana can also interfere with conventional painkillers he may need to prescribe after an oral surgery.