Emergency department visits for gambling disorders doubled following the legalization of single-sports betting in Canada and the expansion of Ontario's gambling market, a University of Toronto study finds - and the increase was concentrated 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. The market now includes 83 gaming and betting sites run by 43 private companies, including some of the world's largest multinational gambling corporations. In 2024, Ontarians wagered $82.7 billion through 2.6 million player accounts.
To assess the effects, researchers analyzed emergency department visits for gambling disorders among Ontarians aged 10 to 105 years before and after the rule changes. The findings were recently published in the American Journal of Preventive Medicine.
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 that 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 among females.
More than 70 per cent of gambling-related emergency department visits involved another mental health condition or heavy substance use. Almost one-third of visits led to a hospital admission.
"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 doctoral student at the 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."
The authors previously reported a substantial increase in gambling-related contacts to ConnexOntario, Ontario's mental health and addiction helpline, following the expansion of online gambling. But that increase could have been explained by greater promotion of the service itself, as gambling ads and websites are required to share ConnexOntario's contact information.
Emergency departments don't get the same promotional push, however, so the new findings add to growing 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 in 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 Hospital.
"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."
The research received support from North York General Hospital and ICES, which is funded by the Ontario Ministry of Health and the Ministry of Long-term Care.
