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Background: During the past two decades of cannabis legalization, the prevalence of medical cannabis (MC) use has increased and there has also been an upward trend in alcohol consumption. As less restricted cannabis laws generate more adult cannabis users, there is concern that more individuals may be simultaneously using medical cannabis with alcohol. A few studies have examined simultaneous use of medical cannabis with alcohol, but none of those studies also assessed patients' current or previous non-medical cannabis use. This paper explores simultaneous alcohol and medical cannabis use among medical cannabis patients with a specific focus on previous history of cannabis use and current non-medical cannabis use. Methods: A retrospective cohort study of MC patients (N = 319) from four dispensaries located in New York. Bivariate chi-square tests and multivariable logistic regression are used to estimate the extent to which sociodemographic and other factors were associated with simultaneous use. Results: Approximately 29% of the sample engaged in simultaneous use and a large share of these users report previous (44%) or current (66%) use of cannabis for non-medical purposes. MC patients who either previously or currently use cannabis non-medicinally, men, and patients using MC to treat a pain-related condition, were significantly more likely to report simultaneous alcohol/MC use. Conclusions: Findings indicate that there may be differential risks related to alcohol/MC use, which should be considered by cannabis regulatory policies and prevention/treatment programs. If patients are using cannabis and/or alcohol to manage pain, clinicians should screen for both alcohol and cannabis use risk factors. [ABSTRACT FROM AUTHOR]