Long used as a laxative by Native Americans of the Pacific northwest, Cascara sagrada bark was not introduced into formal medical practice in the United States until 1877. In 1890, it replaced the berries of the European buckthorn (R. catharticus) as an official laxative. It is still used in over-the-counter laxatives available in every pharmacy in the United States.

Dried, aged cascara sagrada bark is widely accepted as a mild and effective treatment for chronic constipation. The bark contains compounds called anthraquinones (cascarosides A and B) which are transformed by intestinal bacteria into substances that increase peristalsis in the large intestine and help restore its tone.