I have personally used it directly to pay for art, software, medicine, professional services, and charitable contributions.

You can back a debit card with Monero and spend almost anywhere (uquid, or loaddebitcard.com). You can spend it anywhere any shapeshift.io supported coin is accepted.  You can use it at particularly low fees anywhere BTC is accepted using XMR.to (AFAIK - haven't used any of these myself.)

If you are motivated enough to do the advance research and pay the fees, take the counterparty risks, for any required exchange services, you can do pretty much anything with it.  It is not practical for microtransactions at present, and in some scenarios the fees may be an impediment.  Direct merchant acceptance is the ideal, but that will not become prevalent any time soon at, for example, brick-and-mortar retail.  A very nice first step (for valuation impact) would be Amazon acceptance.  As a prime subscriber, I complain about it to Amazon on a regular basis.