Berberis aquifolium is the state flower of Oregon. It is widely used as an ornamental and has been reported as an escape from cultivation in scattered localities across the continent (Ontario, Quebec, central California, Michigan, and Nevada). 

 Berberis aquifolium is resistant to infection by Puccinia graminis .

Medicinally, various root preparations of Berberis aquifolium were used by Native Americans for stomach trouble, hemorrhages, and tuberculosis; as a panacea, a tonic, a gargle, and an eye wash; and to purify blood. Leaves and roots were used in steam baths to treat yellow fever; karok was used as a poison; and the tips of stems were used to treat stomach aches (D. E. Moermann 1986).