Emergency-department visits in Ontario in which gambling disorder was recorded nearly doubled after single-event sports betting was legalised and the province opened its online gambling market to private operators, an observational study has found.
The study, published in the September issue of the American Journal of Preventive Medicine, tracked Ontarians aged 10 to 105 over 14 years before and after the market changes. It recorded 952 emergency visits among 757 people in which a gambling disorder was either the principal or a contributing reason for the visit.
Canada legalised single-event sports betting in August 2021, and Ontario opened a regulated private online gambling market in April 2022. The legal market now comprises 83 betting and gaming sites run by 43 companies. ICES said Ontarians wagered C$82.7 billion through legal online sites in 2024, using 2.6 million player accounts.
The rise in emergency presentations was concentrated among men. By the end of the study period, observed visits were 154% higher than expected among males aged 10 to 29, and 116% higher among men aged 30 to 44. Almost three-quarters of the people included in the study were male, while the analysis found no change in visits among females.
The presentations also pointed to substantial co-occurring health needs. More than 70% involved another mental-health condition or heavy substance use, and almost one-third resulted in hospital admission.
Ryan Forrest, the study’s lead researcher, said the concentration among younger males was particularly concerning given the rapid growth and promotion of online sports betting aimed at that demographic. Daniel Myran, a senior researcher, said emergency presentations may indicate a far larger burden because many people experiencing gambling problems never seek care.
The emergency-department findings provide complementary evidence to a separate Ontario analysis of contacts to ConnexOntario, the province-funded 24-hour mental-health, addictions and problem-gambling information service. That interrupted time-series study examined contacts from January 2012 through September 2025 and found that both the 2015 launch of the government-operated PlayOLG platform and the subsequent private-market expansion were associated with substantial increases in gambling-related contacts.
ConnexOntario received about 746,000 contacts during that 13-year period, including roughly 37,000 related to gambling. The average monthly gambling-contact rate rose from 13.4 per million Ontarians aged 15 and older before PlayOLG to 17.0 after its launch, then to 26.2 after privatisation of the online market.
The helpline analysis likewise identified adolescent boys and men as the most affected groups. During the private-market period, males aged 15 to 44 accounted for 60.3% of all gambling-related contacts, 69.6% of contacts concerning online gambling and 88.9% of sports-gambling contacts.
The researchers said the Ontario evidence should caution jurisdictions considering a rapid expansion of private online gambling. They proposed safeguards including limits on marketing and higher-risk gambling products, alongside improved recognition and treatment of gambling-related harms.
