Emergency department visits for gambling disorders doubled following Ontario’s expansion of its online gambling market, according to research published in The American Journal of Preventive Medicine by University of Toronto scientists.
Canada legalized single-event sports betting in August 2021. In April 2022, Ontario became the first Canadian province to allow private companies to operate in a regulated online gambling market alongside the government-run platform. The province now hosts 83 gaming and betting sites operated by 43 private companies. In 2024, Ontarians wagered $82.7 billion CAD on these sites through 2.6 million player accounts.
Researchers analyzed emergency department visits for gambling disorders among Ontarians aged 10 to 105 years before and after the online gambling expansion. Over the 14-year study period, 757 people made 952 emergency department visits where a gambling disorder was recorded as either the main or contributing reason. Almost three-quarters of these individuals were male.
The increase was concentrated among younger demographics. By the study’s end, observed visits were 154 percent higher than expected among males aged 10 to 29, and 116 percent higher among males aged 30 to 44. There were no changes in females. According to first author Ryan Forrest, a public health doctoral student at U of T’s Dalla Lana School of Public Health, “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.”
More than 70 percent of gambling disorder emergency department visits involved another mental health condition or heavy substance use. Almost one-third of visits led to hospital admission.
The findings complement earlier research showing substantial increases in gambling-related contacts to ConnexOntario, Ontario’s mental health and addiction helpline, following the expansion. Senior author Daniel Myran notes that emergency departments are not promoted through gambling advertisements or websites as a support source, making these increases “important complementary evidence” that online gambling expansion has increased harm.
Myran cautions that most people experiencing gambling problems never seek care, suggesting observed emergency department increases may reflect much larger underlying harms. Alberta became the second Canadian province to allow private online gambling operators in July 2026, with other regions considering similar expansions. Myran recommends that jurisdictions considering such changes “weigh these potential risks” and implement safeguards including marketing restrictions and better recognition of gambling-related harms.
Key facts
- Emergency department visits for gambling disorders doubled after Ontario’s April 2022 online gambling expansion
- The increase was concentrated among males aged 10-29 (154% higher than expected) and 30-44 (116% higher than expected)
- Over a 14-year study period, 952 total ED visits involved gambling disorders, with 71% of visits involving co-occurring mental health conditions or substance use
- Ontario’s legal online gambling market includes 83 sites operated by 43 private companies with $82.7 billion CAD wagered in 2024