For many Native American tribes of the Northern Rockies, Northern Plains, and boreal forest region of Canada and the United States, chokecherries were the most important fruit in their diets. The bark of chokecherry root was once made into an asperous-textured concoction used to ward off or treat colds, fever and stomach maladies by native Americans The inner bark of the chokecherry, as well as red osier dogwood, or alder, was also used by Native Americans in their smoking mixtures, known as kinnikinnick, to improve the taste of the bearberry leaf. The chokecherry fruit can be used to make a tasty jam, jelly, or syrup, but the bitter nature of the fruit requires sugar to sweeten the preserves.
Chokecherry is toxic to horses, and moose, cattle, goats, deer, and other animals with segmented stomachs (rumens), especially after the leaves have wilted (such as after a frost or after branches have been broken) because wilting releases cyanide and makes the plant sweet. About 5–10 kg of foliage can be fatal. Symptoms of a horse that has been poisoned include heavy breathing, agitation, and weakness. The leaves of the chokecherry serve as food for caterpillars of various Lepidoptera. See List of Lepidoptera which feed on Prunus.
In 2007, Governor John Hoeven signed a bill naming the chokecherry the official fruit of the state of North Dakota, in part because its remains have been found at more archeological sites in the Dakotas than anywhere else.
Chokecherry is also used to craft wine in the western United States mainly in the Dakotas and Utah as well as in Manitoba, Canada.