Study Links Ontario iGaming Expansion to Sharp Rise in Gambling-Related ER Visits

TORONTO – Gambling disorder emergency visits in Ontario were 99% higher than expected by mid-2025 following the province’s online gambling expansion. The increase was concentrated among younger men, while more than 70% of visits involved another mental health condition or heavy substance use.

A University of Toronto-led study examined emergency department records covering Ontario residents aged 10 and older between January 2012 and June 2025.

Younger Men Saw the Largest Increase

Researchers identified 952 emergency department visits involving gambling disorder among 757 people during the 14-year study period, with 72% of those individuals male. The peer-reviewed study used an interrupted time-series analysis to examine changes following Ontario’s April 2022 online gambling liberalization.

By the end of the study period, emergency visit rates were estimated to be 154% higher than expected among males aged 10 to 29 and 116% higher among males aged 30 to 44. Researchers found no corresponding change among females, while the overall rate was estimated to be 99% above the level expected without market liberalization.

“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.”

Ryan Forrest
Public health doctoral student, University of Toronto Dalla Lana School of Public Health

Many Visits Involved Other Health Conditions

More than 70% of gambling disorder emergency visits also involved another mental health condition or heavy substance use, while almost one-third resulted in hospital admission. The researchers said emergency department presentations provide a different measure of gambling harm from calls to support services because hospitals are not promoted through gambling advertisements or betting websites as a source of gambling assistance.

The same research team had previously found an increase in gambling-related contacts to ConnexOntario, the province’s mental health and addiction helpline. That measure could potentially have been influenced by increased promotion of support services, while the researchers said the emergency department findings provide complementary evidence involving people experiencing more severe problems.

“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.”

Daniel Myran
Associate professor, University of Toronto Temerty Faculty of Medicine and scientist at ICES

Findings Arrive as Canadian Online Markets Expand

Canada legalized single-event sports betting in August 2021, followed by Ontario’s launch of a competitive private online gambling market in April 2022. Separate research covered in May found that over 91% used regulated sites.

The study also arrives as the private-operator model expands elsewhere in Canada. Alberta became the second province to open a regulated commercial iGaming market in July after confirming its 2026 launch earlier in the year.

Myran said Ontario’s experience should be considered by jurisdictions weighing similar expansion and pointed to marketing restrictions, controls on higher-risk gambling products and improved recognition and treatment of gambling harms as potential safeguards. The researchers emphasized that gambling-related emergency visits remain rare, but said the increase could reflect wider changes in gambling harm across the population.

RELATED TOPICS: Responsible Gambling