Background: In Epirus, Greece, orchids have been traditionally harvested for the production of salep, a beverage made from their tubers. Over-collection of orchids for salep is believed to be a growing threat to wild species, yet very little research has concentrated on orchid populations in the wild. Here, we studied the impact of salep collection on population demographic parameters and uniformity of distribution patterns of the Elder-flowered orchid, Dactylorhiza sambucina, the most commonly collected orchid in northern Greece. Methods: We carried out fieldwork in four meadows where salep harvesting occurs, and conducted interviews in villages close to these sites. Fieldwork focused on the demographic parameters of orchid populations and on the characteristics of their habitat (natural-anthropogenic). We also measured population size and distribution, extent and multi-scale density, comparing distributions to Poisson and fractal models. Results: According to interviews, salep collection by the local community has decreased, contrary to collection by people outside the community, which is increasing. Interviewees did not believe that orchid abundance was higher in the past; they claim that it can be very variable. None of the participants seemed aware of the legislation to conserve orchids. Demographic parameters did not seem to be strongly dependent on whether it was a harvested and non-harvested sites and population density was greatest in the site of highest collection pressure. Conclusions: Our findings show that salep collection is still ongoing in Epirus. Our interview results and our population study indicate that current levels of collection are not significantly affecting the abundance of the Elder-flowered orchid in Epirus subalpine meadows. However, the expanding commercial collection could reach levels that threaten the species. There is a need for a longer-term monitoring of these orchid populations, and a more effective modeling of the species’ response to different harvesting pressures.