After the 2022 privatization of online gambling in Ontario, including legalization of single-event sports betting and expansion of major advertising, the province’s mental health helpline saw a significant jump in calls for gambling-related problems, according to a new study.

Help-seeking contacts increased by 317% among men and teen boys between ages 15 and 24 years and by 108% among men between ages 25 and 44 years.

“This is the group most heavily targeted by sports betting marketing and most likely to participate in online sports betting,” senior author Daniel Myran, MD, Gordon F. Cheesbrough Research Chair in Family and Community Medicine at North York General Hospital in Toronto and a scientist at the Bruy è re Health Research Institute in Ottawa, told Medscape News Canada.

“Gambling is an underrecognized determinant of health, and clinicians should be aware that gambling-related harms may be increasing, particularly among younger men,” Myran said. “Asking about gambling when patients present with mental health concerns, financial stress, or substance use can help identify problems earlier and connect patients to support.”

The study was published on March 2 in CMAJ.

Expansion of Online Gambling

In recent years, online gambling access has expanded broadly in Canada and the US, accompanied by major growth in gambling advertising. In Ontario, online gambling was initially offered in January 2015 through a government-run platform called Play-OLG, which included an online lottery, casino, and instant games.

In 2021, the federal government amended the criminal code to allow single-event sports betting across Canada. In April 2022, Ontario became the first province to create a competitive private online gambling market, which allowed companies to offer and advertise online games and sports betting.

By 2023 and 2024, the province’s gambling market offered 80 gaming and betting sites from 49 private companies, including some of the world’s largest multinational gambling companies, the study authors wrote. More than 2.1 million players wagered $63 billion on the sites in those years.

To observe the health effects of online gambling, the investigators looked at monthly contacts (via phone, chat, email, and text) to ConnexOntario, a free 24-hour mental health and addictions helpline. The research team tracked the following four time periods: before the Play-OLG platform (2012-2014), post Play-OLG launch (2015-2020), the COVID-19 pandemic period (March 2020 to March 2022), and post privatization (April 2022 to September 2025).

Between 2012 and 2025, the helpline received more than 745,000 contacts, including more than 37,000 (5%) for gambling-related issues. Among those with gambling-related concerns, the mean age was 39 years, and 68% were men.

Most gambling-related contacts were self-initiated (68.5%), whereas 21.7% came from family members and 9.8% came from friends or healthcare professionals. The most common types of gambling included electronic gaming machines (46%), table games (25%), and sports gambling (12%).

After privatization in 2022, 9.2% of calls involved gambling-related issues, and 76% of those were for online gambling problems. Overall, gambling-related contacts increased by 96% during the 13-year period.

Between April 2022 and August 2025, total legal monthly wagers increased by 654% from $1 billion to $8 billion, while active player accounts for ages 15 years or older increased by 239%.

Increases in helpline calls occurred almost exclusively among men and teen boys between ages 15 and 44 years, surging by 144% across ages.

“These findings resonate with other emerging data that problem gambling rates are on the rise in Canada,” Luke Clark, PhD, professor of psychology and director of the Centre for Gambling Research at the University of British Columbia in Vancouver, told Medscape News Canada.

Clark, who wasn’t involved with this study, has published articles about the media portrayal of sports betting in Canada since legalization in 2021. Discussions have focused more on the corporate and economic impacts, rather than potential health harms, he noted.

“One of the challenges in monitoring gambling harm, compared with drug-related harm, is that we have few healthcare indicators to work with, such as emergency room visits or toxicology reports, so it’s harder to quantify,” Clark said. “Helpline callers are a useful indicator, and the implications for public health should be taken seriously.”

Advertising Access and Prevention Programs

As online gambling proliferates, the study authors urged stronger prevention measures, such as restrictions on gambling advertisements and limits on the most addictive games, particularly in-play sports betting. As indicated by the growth in helpline calls, gambling participants likely also need greater access to treatment centers, group support programs, and gambling-blocking software, the researchers said.

“There’s often a delay between when someone experiences a gambling problem and when they reach out for help, especially with sports betting and particularly among young men who are even less likely to reach out for help, so this gives an indication of the scope of the potential problem at hand,” Andrew (Hyounsoo) Kim, PhD, an associate professor of psychology and director of the Addictions and Mental Health Laboratory at Toronto Metropolitan University, Toronto, told Medscape News Canada.

Kim, who wasn’t involved with this study, has researched the demographics, psychological characteristics, and harms related to in-play sports betting. He and his colleagues found significant financial and mental harms among young men, which increase when players use alcohol and substances while placing bets.

“Within sports culture, alcohol and sports and betting go hand in hand, which can simultaneously lead to greater harms,” Kim said. “When you make addictive products more available and accessible, you’re going to see an increase in the rates of problems.”

As online expansion continues, other provinces and countries may want to consider these factors related to potential harms, the study authors wrote.

“The notion of licensing private operators to run online gambling — and the heavy marketing that comes along with it — is being considered by other provinces, most notably Alberta,” Nigel Turner, PhD, a scientist with the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health in Toronto, told Medscape News Canada.

Turner, who wasn’t involved with this study, researches problem gambling and has developed a free prevention program. In 2023, he and his colleagues published a brief report on the rise of online betting in Ontario, finding an association between the expansion of legalized gambling and advertising and the number of helpline calls for problem gambling.

“A gambling problem is like other addictions. Recovery is possible. The helpline is a good first step, but clinicians should also consider suggesting that clients call local addiction treatment centers directly,” Turner said. “Treatment works, but like other addictions, relapse is frequent. Like smoking, it might take several tries to quit.”

The study was supported by funds from North York General Hospital. Myran, Clark, Kim, and Turner reported no relevant financial disclosures.

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.