Ontario’s online gambling expansion is linked to a near-doubling of gambling-related ER visits

A University of Toronto study says gambling-related emergency department visits in Ontario have almost doubled since the province opened its online market to private operators. For PSPs and gambling operators, the important bit is not the headline number itself, but the shape of the harm: the increase is concentrated among younger men, with a lot of cases overlapping with mental health conditions or heavy substance use.

1. The study reviewed 14 years of hospital records up to 2025 and covered patients aged 10 to 105. Across that period, researchers identified 757 people diagnosed with gambling disorders, accounting for 952 emergency department visits.
2. Men made up almost three-quarters of the patients, and the strongest growth was among those aged 10 to 29. By the end of the period, gambling-related ER visits among males aged 10 to 29 were 154 per cent above the level researchers would have expected if Ontario had not expanded its online gambling market.
3. Visits among men aged 30 to 44 were also higher than projected, reaching 116 per cent above the expected level. The researchers did not find a comparable increase among women.
4. More than 70 per cent of the emergency visits involved another mental health condition or heavy substance use, and almost one-third ended with the patient being hospitalised. The findings were published in the American Journal of Preventive Medicine and follow earlier research that recorded more gambling-related contacts with ConnexOntario after the online market expanded.
5. Ontario expanded its online gambling market in April 2022, several months after single-event sports betting became legal across Canada in August 2021. The province now has 83 regulated betting and gaming platforms run by 43 companies, and 2.6 million player accounts wagered CAD 82.7 bn in 2024.

For jurisdictions watching Ontario, the study’s practical message is straightforward: hospital data is a separate harm signal from operator support channels and ad-driven treatment awareness. The authors point to tighter gambling-advertising controls, restrictions on higher-risk products, and better identification and treatment of gambling-related problems as possible responses.