Some taxonomic dispute exists for the species. Variation in leaf morphology is used by some authors to distinguish forms into distinct species (Weakley and the Southeastern Flora Team 2022). At present, these distinctions are not universally agreed upon. Acceptance of these taxonomic changes would likely result in substantial change to the extinction risk of some subpopulations. Further study is needed to clarify the taxonomic status, distribution, and population of these variants.

Aristolochia serpentaria is an erect perennial herb that occurs in much of eastern North America. More information is needed to assess the total population of the species as well as to address taxonomic uncertainty. The species is tolerant of a range of habitats but is relatively rare throughout its distribution due to low levels of recruitment. Basic research is required to determine generation length and fecundity. Without this data sustainable harvest rates cannot be determined, nor can the severity of the impact of harvest pressure. Despite recent research demonstrating toxicity of the species and highlighting the danger associated with herbal remedies containing material from Aristolochia spp., collection of wild specimens continues with no sign of market decline. Though these pressures show no indication of abating, the species occurs over a very large area and shows signs of recovery throughout the 20th century in some areas. Because no obvious population trend is evident and the species has a wide distribution and an apparently large population, it is listed as Least Concern. However, given recent taxonomic disputes and the possibility that the multiple species may exist within the currently recognized species concept, harvest pressure and habitat loss may present a substantial extinction risk to genetically unique varieties and further study is recommended.

Virginia Snakeroot (Aristolochia serpentaria) has a broad distribution and occurs at low densities across wooded areas of the eastern United States. Its range extends along the Gulf Coast from Texas to Florida northward to Michigan and New York and from the Atlantic Coast westward to Iowa, Kansas, and Oklahoma. The species may have been extirpated from Kansas (NatureServe 2018). It occurs at elevations ranging from 50 to 1,300 metres (Flora of North America Editorial Committee (FNA) 1997). Subpopulations in Peninsular Florida characterised by narrow leaves have been described by some authorities as A. nashii Kearney (Weakley and the Southeastern Flora Team 2022). Considerable dispute exists surrounding the taxonomic status of these plants. At present, they are included in this assessment. However, future taxonomic research could result in substantial changes to the range and conservation status of the species.

Data on total population is sparse but may be estimated from subpopulation level data. The total number of subpopulations is likely to be in the thousands with each typically containing one to two dozen individuals. Isolated subpopulations contain over 100 plants (NatureServe 2018). Total population is likely to be in the hundreds of thousands. No obvious pattern exists in the total population trend.

Reported levels of harvest suggest that the population is much greater than surveys suggest. The 2004 harvest (an exceptionally large harvest year) was estimated to be 160 kg (AHPA 2012). With each plant yielding one to two grams of wet roots this represents a minimum of 80,000 collected plants. The average harvest between 2000 and 2010 (45 kg per year) suggests an annual average of at least 22,500 collected plants. These figures likely dramatically underestimate the total numbers as data is based on voluntary surveys taking into account only a small portion of distributors. Given the weight lost during desiccation figures may be extrapolated to even larger values.

Aristolochia serpentaria occurs in a wide variety of upland soils and forest types but is intolerant of wetlands and non-forested areas (Allard 2002). Despite this tolerance of varied habitats, re-colonization of disturbed habitats is rare (Dávalos et al. 2015). Few plants flower in a given year and plants rarely have more than two flowers. Flowers appear to be either fly pollinated chasmogamous, or cleistogamous (Allard 2002). Little is known about recruitment levels, but experimental results show low seedling emergence rate (Dávalos et al. 2015). Fruits, containing 15-24 seeds, ripen in late summer (August-September) and are gravity dispersed short distances. Lifespan is not known for A. serpentaria, but is likely to be around 20 years as has been estimated for other members of the genus (Rausher and Feeny 1980).

Though predation pressures imposed by deer are very low, deer populations may negatively impact subpopulations through trampling or other mechanisms (Dávalos et al. 2014). The pipe vine swallowtail (Battus philenor) feeds on various species of Aristolochia including A. serpentaria (Rausher 1980). Individual caterpillars may consume dozens of plants (Rausher and Feeny 1980) and the wide spacing of A. serpentaria may be a response to this pressure (Allard 2002). Seed predation by turkeys may also impact population, though the magnitude is not known (Dávalos et al. 2015).

Estimates of aggregate annual harvest show variable demand averaging 45 kg (ranging from 17 to 160 kg) of dried root annually between 1999 and 2010 (AHPA 2012). Individual plants may yield one to two grams of wet roots. These figures likely represent only a small fraction of demand. Habitat loss resulting from expansion of urban areas may also impact some subpopulations.

Historically, Aristolochia serpentaria has been used by Benedictine monks as a diuretic, an excitant, and as an herbal remedy for bronchitis and fevers (Medeiros and de Albuquerque 2012). The species was used as a substitute for quinine in the treatment of malaria during the 19th century (Hasegawa 2007) and has been used as a treatment for snakebites (Molander et al. 2012). The dried rhizome of the plant, which has a snake-like appearance, is typically prescribed, though some applications call for the leaves or root (Heinrich et al. 2009).

A. serpentaria is known to contain aristolochic acid, which is associated with degenerative kidney disorders (Heinrich et al. 2009). Recent evidence also suggests the compound may be carcinogenic. The FDA has issued warnings against use of the herb and advised consumers to discard any herbal remedies containing the herb (Debelle et al. 2008). Despite these warnings and restrictions, demand continues and buyers advertise prices up to $90 per pound of dried root. Trade also continues due to purported psychotropic properties. Much of this trade occurs in underground markets and existing trade figures likely underestimate demand. More research is needed to better characterise the impact of collection on the population of the species.

The species is listed as Threatened in Connecticut, Iowa, and Michigan and is protected from collection on public lands (Allard 2002, USDA, NRCS 2018). In New York, the species is listed as Endangered, and in Illinois a variety (A. serpentaria var. hastata) is listed as threatened (USDA, NRCS 2018). It is incidentally protected as it likely occurs in numerous protected areas throughout the eastern United States.