Despite their wide distribution, the eastern box turtle population is declining due to a variety of human threats. Agriculture and urbanization have destroyed their habitat, eastern box turtles are often found crushed to death on highways, and the international pet trade has had an impact. And their habits (long lives and low fertility rates) make them particularly vulnerable. The Carolina box turtle is already on the IUCN Red List of vulnerable species.
It is also listed in Appendix II of the Convention on International Trade in Endangered Species of Wild Fauna and Flora, which means that "the trade situation needs to be regulated to avoid affecting the survival of the species". In addition, some states in the United States have controlled or banned the importation of the turtle. In Mexico, the situation is no better.