This has a broad range across southeastern states, but it is rare in most of them, and there are very few records from the Ohio River watershed, especially Ky. and Tenn. (K, NS) Habitats are described as "pine savannas, bogs, fens, seeps, wet seepage-fed forests" (W). Because its foliage and roots contain highly toxic alkaloids, they are not normally eaten by mammalian herbivores; it is especially poisonous to horses (illinoiswildflowers.info). Weiherer et al. (2020) recently studied the pollination ecology in Mo., and they reported: "Each flower lived 9-11 days and smelled of raw liver and latex... We interpret low reproductive success as one explanation for current declines in populations of this species." In Ky., it is known only from the Blood River Seeps of CALL, where discovered by R. Athey in the 1970s (MUR etc.); it may survive in or near the new nature preserve there. Adjacent to Ky., there are also old records from Floyd Co., Ind. (D); Hamilton Co. (PA) and Adams Co. (OS). Ohio.