When online gambling became significantly easier in Ontario, emergency department (ED) visits for gambling disorders nearly doubled, according to a new observational study.

The data were published on September 15 in the American Journal of Preventive Medicine.

Single-event sports betting was legalized in Canada in 2021. Then, in April 2022, Ontario became the first province to legalize online gambling operated by private companies.

To understand the impact of the policy changes, researchers reviewed records over a 14-year period before and after the policy change. During that time, 757 patients visited the ED either because of an underlying gambling disorder or, more often, for another mental health or substance-related crisis in which gambling disorder was a contributing factor.

Gambling disorder was the primary reason for 29.3% of visits; 72.1% of visits also involved another mental health or substance-related condition.

Before the policy changes, the observed rate of ED visits was steady. By the end of the study period, the number of visits was significantly higher than would be expected in the absence of a policy change. Specifically, visits were 99% higher than expected by the second quarter of 2025.

“These emergency department visits really were relatively stable before the changes in market and the expansion happened but began increasing afterwards,” Rachael MacDonald-Spracklin, study co-author and PhD candidate at Dalhousie University in Halifax, told Medscape News Canada. “This was definitely a gradual increase over time, and by the end of our study period…rates were about twice as high as what we would have expected based on the trends that existed before gambling liberalization.”

The study was observational and therefore can’t prove that the policy changes led to the increase, but researchers said that it adds to a growing body of evidence suggesting that these policy changes increase the risk for gambling addiction, especially among young men.

Greater Effect Among Men

The pattern warrants clinicians’ attention, Chanelle Ramsubick, MD, double board-certified child, adolescent, and adult psychiatrist who was not involved in the study, told Medscape News Canada.

“It’s an observational study, so we can’t really say that gambling being legal online is the cause of emergency room visits because of gambling disorder increasing…. But clinically, when you see a pattern this large, I think it’s something that should get our attention,” Ramsubick said.

While rates nearly doubled overall, the effect appeared worse among men. Specifically, rates were 114% higher than expected among men aged 10-29 years and 71.7% higher among men aged 30-44 years.

“The population that we’ve observed the greatest increase in also happens to be the population that has been particularly engaged and exposed to the rapidly expanding market,” MacDonald-Spracklin said.

“When I saw that this was younger men, too, that didn’t surprise me. Younger men are a population who are exposed to sports betting, online gambling, more likely to be using technology,” Ramsubick said.

“When we see a clinical picture of a younger man who comes in with substance abuse, acute decompensation, it should also be in the back of our mind that we should also assess for potential gambling,” Ramsubick said, suggesting providers use nonclinical language, such as asking whether patients are “sports betting online” rather than asking whether they have a gambling disorder.

“The way we speak about it needs to be nonjudgmental to reduce the stigma and shame in these conversations,” Ramsubick said.

A Public Health Concern

Previously, the same research team showed substantial increases in the number of people seeking help via ConnexOntario, the province’s addiction helpline. It wasn’t clear, however, if that increase could be attributed to increased advertising and awareness of the helpline following the expansion of online gambling. It’s uncommon for people to seek help with gambling at the ED.

Overall numbers were relatively low over the 14-year period, with most visiting in crisis for another mental health reason and with gambling contributing to the reason for the visit.

“We are identifying some of the most severe cases of gambling disorder. It is rare that anybody will ever present to an emergency department, and if they do, obviously it’s going to be bad,” said MacDonald-Spracklin.

However, this new study offers evidence supporting the idea that there’s a genuine increase in gambling-related harm rather than just better awareness of gambling addiction help and support services, she added.

The increasing popularity of these sites also suggests that more people are at risk. At least 43 private companies operate at least 83 gambling and betting sites, according to ICES, an independent, not-for-profit research and analytics institute that supported the study. People living in Ontario bet $82.7 billion over 2.6 million player accounts in 2024, according to ICES.

“Online is so much more accessible. It’s in your pocket, right? Really, you pull your phone out and you can place a bet…. Not only is it easy for you to do this on the go…but you’re also being reminded that you’re able to do that,” MacDonald-Spracklin said.

In July 2026, Alberta became the second province to allow private companies to offer online gambling.

“Gambling harms often stretch further than the individual in front of them…. There could be some type of consideration in that, almost integrated into the care…of the individual, and if there’s other people around them that perhaps may also be involved,” said MacDonald-Spracklin.

The study was supported by North York General Hospital and ICES. MacDonald-Spracklin and Ramsubick reported no relevant financial relationships.

Sony Salzman is an Emmy Award-winning journalist covering science and medicine. As an independent journalist, her work has appeared in The Atlantic, STAT News, NBC, MedPage Today, The Boston Globe, Al Jazeera, VICE, and WBUR. Previously, she worked as coordinating producer of ABC News Medical Unit, where she directed health, science, and medical coverage across Good Morning America, World News Tonight, Nightline, ABCNews.com, and ABC News Live.