First described in 1774, the mushroom has a wide distribution in the Northern Hemisphere, where it grows on the ground in damp woodlands in a mycorrhizal association with conifers, especially pine.

There are many similar Russula species that have a red cap with white stem and gills, some of which can be reliably distinguished from R. emetica only by microscopic characteristics.

According to the nomenclatural database MycoBank, Agaricus russula is a synonym of R. emetica that was published by Giovanni Antonio Scopoli in 1772, two years earlier than Schaeffer's description.

[8] Additional synonyms include Jean-Baptiste Lamarck's Amanita rubra (1783), and Augustin Pyramus de Candolle's subsequent new combination Agaricus ruber (1805).

[17] The sticky cap of R. emetica is 2.5–8.5 cm (1.0–3.3 in) wide, with a shape ranging from convex (in young specimens) to flattened, sometimes with a central depression, and sometimes with a shallow umbo.

It is a bright scarlet or cherry red, and in maturity, the margins have fine radial grooves extending 2–7 mm (0.08–0.3 in) towards the center of the cap.

The brittle flesh is white (or tinged with red directly under the cap cuticle), measures 4–9 mm (0.2–0.4 in) thick, and has a very sharp and peppery taste.

Gills are closely spaced, white to creamy-white, and have an attachment to the stem ranging from adnate to adnexed or completely free.

[23] The edible R. rugulosa—common in mixed woods in the eastern and northern United States—has a wrinkled and pimpled cap cuticle, cream spores, and mild taste.

[26] R. nana is restricted in distribution to arctic and subarctic highland meadows where dwarf willow (Salix herbacea) or alpine bearberry (Arctostaphylos alpina) are abundant.

[27] Like all species of Russula, R. emetica is mycorrhizal, and forms mutually beneficial partnerships with roots of trees and certain herbaceous plants.

[22] Fruit bodies grow singly, scattered, or in groups in sphagnum moss near bogs, and in coniferous and mixed forests.

[29] In a study of the fungal diversity of ectomycorrhizal species in a Sitka spruce forest, R. emetica was one of the top five dominant fungi.

[25] The mushroom used to be widely eaten in eastern European countries and Russia after parboiling (which removes the toxins), and then salting or pickling.