ER Visits for Gambling Doubled After Online Betting

The StudyWhat the researchers counted

Ontario is a good place to ask this question, for an uncomfortable reason. Every emergency department visit in the province flows into one administrative dataset, held by the Institute for Clinical Evaluative Sciences (ICES). Researchers there can see the whole population, not a sample, and they can see it before and after a policy changes.

The team, led by Ryan Forrest, a public health doctoral student at the University of Toronto, with senior author Dr. Daniel Myran of North York General Hospital, pulled every ED visit coded to gambling disorder across 14 years. They found 757 people who made 952 visits. Seventy-three percent were male. The patients ranged in age from 10 to 105.

Then they laid two dates over the curve. In August 2021, Canada legalized single-event sports betting, the kind where you bet on one game rather than a parlay. In April 2022, Ontario became the first province to open a regulated private market for online casinos and sportsbooks. By 2024, that market had 83 sites, 2.6 million player accounts, and $82.7 billion in collective wagers.

The NumbersWho showed up

The headline is that visits doubled. The detail underneath it is sharper.

Men carried all of it. Visits by males aged 10 to 29 came in 154% above what the pre-expansion trend predicted. Men aged 30 to 44 were 116% above. Among women in both age bands, the researchers observed no change at all.

"The concentration of the increase among younger males is particularly concerning given the rapid growth and promotion of online sports betting."

Ryan Forrest, lead author

The visits were serious. Over 70% involved another mental health condition or heavy substance use. Nearly one in three led to admission. Nobody goes to an emergency room because they lost a parlay. They go because they are in crisis, and gambling is the reason they are in crisis.

That last point is why Myran's framing is the right one:

"This is the tip of the iceberg of something. How big is that iceberg?"

What It Does and Doesn't ProveReading it honestly

This is an observational study, and the authors say so. It shows what happened to ED visits after two policy changes. It cannot, on its own, prove that the policy changes caused the increase. Other things changed in Ontario between 2021 and 2025, including the end of pandemic restrictions and the return of live sports.

Three things make the finding hard to wave away, though.

The sex split. If the increase were driven by something general, like post-pandemic mental health strain or better coding, you would expect it to show up in women too. It didn't. It showed up in exactly the group that online sportsbooks market to hardest.

The shape. A steady 7% quarterly climb tracks a market that kept adding accounts, not a one-off shock.

The convergence with U.S. data. Ontario is the cleanest natural experiment, but it is not the only one. In the United States, an Epic Research analysis found diagnosed gambling disorder rose more than 60% in states that legalized sports betting while falling where it stayed illegal. A multi-state study in Information Systems Research tied online sports betting legalization to a 22.8% rise in helpline calls, which we covered in Michigan's helpline story. Different countries, different datasets, different outcome measures, same direction.

None of those studies is proof by itself. Together, they are a pattern.

The GapWhy an ER is the wrong first door

There is one more detail in the Ontario coverage worth sitting with. Gambling platforms in the province carry a disclaimer pointing to ConnexOntario, the provincial helpline. None of them point to an emergency room. And yet the emergency room is where a growing number of people end up, because by the time the problem is visible, it has become a mental health crisis, a substance crisis, or both.

That gap is the whole reason this site exists. The route from "this is getting bad" to "I'm in an ER" runs through months in which a person tells no one. Nine in ten people with a gambling problem never get help of any kind, a figure we have written about before. The Ontario study is what the other one in ten looks like when they finally arrive, and it is the worst possible version of arriving.

You do not have to wait for that. If gambling is costing you sleep, money you can't explain, or the truth with people you love, free, confidential help is here and a two-minute self-check will tell you where you stand. If someone you love is the one who is somewhere else at the dinner table, how to help someone with a gambling addiction is written for you.

Sources

• Emergency Department Visits for Gambling Disorders After the Legalization of Single-Event Sports Betting and Rapid Expansion of Online Gambling, Forrest R., Myran D.T. et al., American Journal of Preventive Medicine, September 2026
• Emergency room visits for gambling disorders nearly doubled after expanded online gambling market, ICES / North York General Hospital release via EurekAlert, September 16, 2026
• "Tip of the iceberg": More Ontarians with gambling disorders are showing up in emergency departments, study finds, CP24, September 16, 2026
• ER visits for gambling disorders skyrocket after online sports betting legalized, Deseret News, September 16, 2026
• Gambling disorder diagnoses have risen more than 60% in states that legalized sports betting, Epic Research, June 26, 2026
• Let It Ride! An Empirical Investigation of Problem Gambling and the Implications of Legalized Online Sports Betting, Greenwood, Ozer and Gopal, Information Systems Research