Ontario Gambling-Disorder Emergency Visits Doubled Once Its Online Market Opened

A University of Toronto and ICES study of 14 years of hospital records finds visits 154% above the expected level among males aged 10 to 29 and 116% above among men aged 30 to 44, with no change in females. The authors call it a caution for Alberta and every province considering private online operators.

• Emergency department visits for gambling disorders in Ontario nearly doubled after Canada legalised single-event sports betting in August 2021 and the province opened its online market to private operators in April 2022, according to a study published on 16 September in the American Journal of Preventive Medicine
• Researchers at the University of Toronto and ICES analysed visits by Ontarians aged 10 to 105 from January 2012 to June 2025, finding 757 people with 952 visits in which a gambling disorder was the main or a contributing reason; almost three-quarters were male
• By the end of the period, visits were 154% higher than expected among males aged 10 to 29 and 116% higher among men aged 30 to 44; there was no change among females
• More than 70% of the visits involved another mental health condition or heavy substance use, and almost a third led to hospital admission
• Senior author Daniel Myran said the data "provide an important caution" for jurisdictions such as Alberta, which opened its own private market in July, and recommended "restrictions on marketing and higher-risk forms of gambling"

Hospital Records Say What the Helpline Could Not Prove

Emergency department visits for gambling disorders in Ontario doubled following the legalisation of single-event sports betting and the expansion of the province's online gambling market, according to a study by University of Toronto researchers published on Wednesday in the American Journal of Preventive Medicine, the university's Temerty Faculty of Medicine said in a statement. The increase was concentrated among young men.

The timeline the study tests is specific. Canada legalised single-event sports betting in August 2021, and in April 2022 Ontario became the first province to license private operators alongside the government-run platform. The market now has 83 gaming and betting sites run by 43 companies, and in 2024 Ontarians wagered CA$82.7 billion, approximately $59 billion, through 2.6 million player accounts, the statement says. The researchers compared emergency visits for gambling disorders among Ontarians aged 10 to 105 before and after the expansion, over a 14-year window from January 2012, when the Ontario Lottery and Gaming Corporation launched its own online offering, to June 2025.

Over the period, 757 people made 952 emergency visits in which a gambling disorder was recorded as the main or a contributing reason. Almost three-quarters were male. By the end of the study period the observed number of visits was 154% higher than expected among males aged 10 to 29 and 116% higher among males aged 30 to 44, with no change among females. More than 70% of the visits involved another mental health condition or heavy substance use, and almost a third led to 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," said first author Ryan Forrest, a doctoral student at the Dalla Lana School of Public Health. The team had previously reported a rise in gambling-related contacts to ConnexOntario, the province's helpline, but noted that helpline trends could be explained by the requirement for gambling advertising to display the helpline number. Emergency departments, the statement observes, are not promoted in gambling advertisements, which makes the new finding "important complementary evidence".

The Authors' Message to the Rest of Canada

"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," said senior author Daniel Myran, an associate professor at the Temerty Faculty of Medicine and a scientist at ICES. Alberta became the second province to admit private operators in July, and others are "considering or facing pressure to follow suit", he said. "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." Neither the university's statement nor the CBC's report of the study carries a response from iGaming Ontario or the Alcohol and Gaming Commission of Ontario.

The Numbers Are Small, the Design Is the Point

Nine hundred and fifty-two emergency visits across 14 years in a province of 16 million people is not an epidemic, and the authors do not call it one. What the study does is compare an observed trend against the trend that would have been expected without the 2022 change, and find a break at the change concentrated in the group the products are marketed to. That is the design that helpline data could not support, because the helpline number is on every advertisement. A regulator can argue about attribution, and should, since the same period saw the end of pandemic restrictions and the launch of a national sports-betting product that would have existed with or without private operators. What it cannot argue is that the signal is a promotional artefact. Emergency departments do not advertise.

Ontario's Model Is Being Exported at the Moment Its Costs Are Being Measured

The province's regulated market has been the template for Canadian expansion, with record handle and a channelisation argument that the private market brought players out of the grey market and under protection. That argument and this study are not contradictory: a market can capture offshore players and still increase total harm if it also grows the total. The authors' recommendation, marketing restrictions and limits on higher-risk products, is the same one the Lords committee reached in Britain this week and that Australia has legislated. Alberta, which launched with 31 sites and an advertising code that already bars athletes from casino ads, is the first province that will have to say whether Ontario's numbers change its own.

The Cohort Is the One Every Regulator Says It Protects

Males aged 10 to 29 is a range that starts nine years below Ontario's legal gambling age of 19. The study does not separate minors from adults within it, and the statement does not say how many of the 952 visits involved under-19s, which is the number the province will want before it responds. What the range does establish is that the increase is in young men, that it is absent in women, and that most of it arrives at the emergency department alongside another mental health condition or substance use. Those are the patients the AGCO's guidance on identifying players at risk exists to find earlier. The hospital data suggests the finding is happening, but late.

Ontario built the market the rest of Canada wants to copy. Its own hospitals have now filed the first bill.