ER visits for gambling disorders doubled after expanded online gambling market

Emergency department visits for gambling disorders doubled following the legalization of single-event sports betting and expansion of Ontario's online gambling market, according to a new study by University of Toronto researchers. The increase was observed predominantly among young men. Canada legalized single-event sports betting in August 2021. In April 2022, Ontario became the first province to allow private companies to operate in a regulated online gambling market alongside the existing government-run platform. Ontario’s online legal gambling market currently includes 83 gaming and betting sites operated by 43 private companies, including some of the world’s largest multinational gambling corporations. In 2024, Ontarians wagered $82.7 billion CAD on these sites through 2.6 million player accounts. To assess the effects of these changes, researchers analyzed emergency department visits for gambling disorders all among Ontarians aged 10 to 105 years before and after the online gambling expansion to private companies, which included legalizing single-event sports betting. Over the 14-year study period, 757 people had a total of 952 emergency department visits in which a gambling disorder was recorded as either the main or a contributing reason for the visit. Almost three-quarters of these individuals were male. By the end of the study period, the observed number of visits was 154 per cent higher than expected among males aged 10 to 29; and 116 per cent higher than expected among males aged 30 to 44. There were no changes in females. More than 70 per cent of gambling disorder emergency department visits involved another mental health condition or heavy substance use and almost one-third of the visits led to hospital admission. The findings were published in The American Journal of Preventive Medicine. “The concentration of the increase among younger males is particularly concerning given the rapid growth and promotion of online sports betting, which target this demographic,” says first author Ryan Forrest, a public health doctoral student at U of T’s Dalla Lana School of Public Health. “The consequences of rising gambling involve not just harm to people who are gambling but wider effects on families and communities.” Past research has shown that individuals with gambling problems seldom pursue formal treatment due to stigma, and those who seek help often do so only after worsening health and social harms. The author team previously reported a substantial increase in gambling-related contacts to ConnexOntario, Ontario’s mental health and addiction helpline, following the expansion of online gambling. However, the increases in helpline trends could have been explained by greater promotion of gambling support services, including requirements for gambling advertisements and websites to display contact information for ConnexOntario. The new findings provide important complementary evidence as EDs are not promoted through gambling advertisements or betting websites as a source for gambling support. Collectively, increases in both helpline contacts and severe gambling-related presentations to the emergency department add to evidence that the expansion of online gambling has been accompanied by an increase in gambling-related harm, particularly among younger men. “Most people experiencing gambling problems will never seek care, so the concern is that the increases in emergency department visits for gambling disorders we observed may be revealing much larger increases in gambling-related harm,” says senior author Daniel Myran, an associate professor of family and community medicine at U of T's Temerty Faculty of Medicine and a scientist at ICES. In July 2026, Alberta became the second province to allow private operators to offer online gambling, “and other regions of Canada are considering or facing pressure to follow suit,” says Myran, who is also the Gordon F. Cheesbrough Research Chair in Family and Community Medicine at North York General. “Data from Ontario provide an important caution about the potential harms that can accompany rapid expansion of online gambling,” continues Myran. “Jurisdictions considering expanding or offering online gambling through private operators should carefully weigh these potential risks and, if proceeding, consider additional safeguards, including restrictions on marketing and higher-risk forms of gambling, alongside better recognition and treatment of gambling-related harms.”