This southeastern species was originally concentrated on relatively acid soils, especially in Appalachian regions, but it has now become widely cultivated. Open dots in the map include unverified historical data of Gm, plus colls. that may not be from truly native plants. Seedlings occasionally establish from plantings, and it is becoming difficult to distinguish native plants in less forested regions. However, it can be assumed that virtually all trees in the Bluegrass region are adventive, since there are no records of this species here before Gm in 1913. A horticultural hybrid with the southeastern species, Ilex myrtifolia Walt, is known as X attenuata Ashe; it is widely grown and has escaped locally near the arboretum at Bernheim Forest (BULL). Although some medicinal value has been attributed to opaca, there is virtually no reliable documentation (Alikaridis 1987); the species does not appear to produce caffeine (Negrin et al. 2019).