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Outside the emergency room entrance at Mount Sinai Hospital, in Toronto. By June, 2025, the overall rate of gambling-related emergency visits was 99% higher than what it was expected to be if Ontario hadn’t expanded its online gambling market, the study found.Ian Willms/The Globe and Mail
Emergency-room visits for gambling disorders have nearly doubled since Ontario opened its online gambling market to private companies and sports betting, with males aged 10 to 29 accounting for the biggest increases, a new Canadian study has found.
Published Wednesday by the American Journal of Preventative Medicine, the study analyzed 952 visits to ERs across Ontario between January, 2012, and June, 2025, in which problem gambling was the primary or contributing cause. Most cases involved another mental-health condition or substance-related harm, including major depression, alcohol use or self-harm.
A team of researchers found that gambling-related ER visits remained stable until April, 2022, when Ontario launched its regulated market for private operators to offer online gambling and single-event sports betting.
Since then, emergency admissions have ticked upward. By June, 2025, the overall rate of gambling-related emergency visits was 99-per-cent higher than what it was expected to be if Ontario hadn’t expanded its online gambling market, the study found – increases that occurred exclusively in boys and men between 10 and 44.
But the jump was most acute in the 10 to 29 age group, which saw a startling 154-per-cent increase in ER admissions. While these types of ER visits remain relatively rare, the numbers likely only capture the “tip of the iceberg” when it comes to the broader potential harms, according to the study authors.
“It makes me worry about a public-health crisis,” said senior author Daniel Myran, a University of Toronto associate professor and scientist with ICES, a non-profit Ontario research institute. “The reaction I had on first seeing these numbers is, this is really bad.
“The people in the study are just a tiny, tiny fraction of the people who gamble, and a tiny fraction of the people with gambling problems. But what is that fraction? That’s the big unknown right now.”
This new study builds on earlier research conducted by Dr. Myran and co-author Ryan Forrest, a doctoral student with the University of Toronto’s Dalla Lana School of Public Health.
In March, they published a paper in the Canadian Medical Association Journal reporting on a “substantial increase” in gambling-related calls to ConnexOntario, the province’s mental health and addictions helpline, after the introduction of sports betting and privatized online gambling. Among boys and men aged 15 to 24, they observed increases of more than 300 per cent.
But an outstanding question was the extent to which these increases were driven by a rise in problem gambling versus greater awareness of ConnexOntario as a resource, said Tara Elton-Marshall, an associate professor with the University of Ottawa, who was not involved with either study. Contact information for ConnexOntario is published on every legal gambling website and included in advertisements for online gambling.
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This follow-up study, however, provides direct evidence of “clinically significant harms” linked to the introduction of privatized online gambling and single-event sports betting in Ontario, she said.
“It’s a really critical study,” said Dr. Elton-Marshall, who studies gambling and policy evaluation. “There are harms that we’re seeing as a function of the legalization that’s happening, and it’s not relying on self-reported data. It’s actually a physician that’s determining that this is a certain level of harm.”
This new study also highlights the heightened risk for marginalized communities when it comes to problem gambling; patients who visited ERs for gambling disorders were more likely to live in the lowest-income neighbourhoods, the study found.
As the first Canadian province to privatize online gambling, Ontario has become a kind of a “natural experiment to evaluate the health effects of gambling liberalization,” according to this new study.
Today, the province has 49 operators collectively running 84 websites that offer casino games, card games and sportsbooks. In 2024-25, Ontarians wagered $82.7-billion.
Other provinces are now looking to follow in Ontario’s footsteps. This summer, Alberta became the second Canadian province to regulate private online gambling operators.
But other provinces should pay attention to the public health data starting to emerge from Ontario, Dr. Myran said.
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In addition to his own research, the Ontario Student Drug Use and Health Survey recently found that online gambling has “significantly increased” among teenagers in the province, with one in eight gambling online during the past school year and one in 10 betting on sports.
A survey study by the Canadian Centre on Substance Use and Addiction also reported last year that 69.4 per cent of young adults aged 18 to 29 who gambled online met the criteria for problem gambling.
“Other provinces should look at this,” Dr. Myran said. “There are now multiple warning signals coming out about meaningful health and social harms that could arise from this.”