What happened when Canada let private companies run online sports betting

A gambling disorder might not immediately come to mind as an ailment that would send someone to a hospital emergency room.

But a new study shows emergency department visits — predominantly among young men — nearly doubled following the legalization of online sports betting and expansion in the Canadian province of Ontario.

Canada legalized single-event sports betting in 2021. A year later, Ontario became the first province to allow private companies to operate in a regulated online gambling market alongside the existing government-run platform. Currently, 43 private companies, including some of the world’s largest multinational gambling corporations, run 83 betting and gaming sites in Ontario. In 2024, Ontarians bet $82.7 billion CAD on those sites through 2.6 million accounts.

ICES, an independent, nonprofit research institute in Ontario that uses population-based health data to improve healthcare, analyzed emergency room visits for gambling disorders among people aged 10 to 105 before and after the expansion to private companies. The results were published in the September issue of The American Journal of Preventive Medicine.

Over the 14-year study period, 757 people had a total of 952 emergency room visits in which a gambling disorder was either the main or a contributing reason for the visit. Nearly three-quarters of the patients were male.

While the absolute numbers are small — reflecting how rarely gambling disorders are formally diagnosed in emergency settings — the rate of change after privatization was dramatic.

Researchers found the number of visits was 154% higher than expected among males aged 10 to 29 and 116% higher than expected among males aged 30 to 44. Among females, there was no significant change. More than 70% of the emergency room visits involved another mental health condition or heavy substance use, and almost a third led to hospitalization.

“The concentration of the increase among younger males is particularly concerning given the rapid growth and promotion of online sports betting,” study first author Ryan Forrest, a University of Toronto public health doctoral student, said in a press release. “The consequences of rising gambling involve not just harm to people but wider effects on families and communities.”

Reaching out for help

Past research has shown that people with gambling problems seldom pursue treatment, and those who do seek help often do so only after worsening health and social harms.

“Most people experiencing gambling problems will never seek care, so the concern is that the increases in ED visits for gambling disorders we observed may be revealing much larger increases in gambling-related harm,” said study senior author Daniel Myran, the Gordon F. Cheesbrough Research chair at North York General, a scientist at ICES and an associate professor in the Department of Family and Community Medicine at the University of Toronto.

A study Myran and his colleagues published in March 2026 in the Canadian Medical Association Journal found a substantial increase in gambling-related calls — again mostly among young men — to ConnexOntario, the province’s mental health and addiction helpline, after the expansion of online gambling.

Helpline contacts increased 96% overall during the 2012–2025 study period. But contacts surged 317% among men and teen boys ages 15–24 and 108% among men ages 25–44 after privatization.

“This is the group most heavily targeted by sports betting marketing and most likely to participate in online sports betting,” Myran said, per Medscape.

Researchers, though, said the increase could have been the result of greater promotion of gambling support services, including requirements for gambling advertisements and websites to display contact information for ConnexOntario.

Increases in both helpline contacts and severe gambling-related emergency department visits add to evidence that expansion of online gambling has been accompanied by more harm, particularly among young men, according to researchers.

Myran said gambling is an underrecognized determinant of health, and clinicians should be aware that gambling-related harms might be increasing.

“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,” he said.

A second Canadian province allows online betting

This past July, Alberta became the second province to allow private online gambling operators. Myran said other regions of Canada are also considering or facing pressure to follow suit.

“Data from Ontario provide an important caution about the potential harms that accompany rapid expansion of online gambling,” 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.”

Gambling disorder diagnoses rise in the U.S.

In the U.S., 39 states have legalized sports betting in some form, including 30 that allow wagering via smartphone apps or websites. Utah and Hawaii are the only states that prohibit all forms of gambling.

An Epic Research review of electronic health records for nearly 200 million American adults found gambling disorder diagnoses rose 61% in states that legalized sports betting since 2018, from 3.0 to 4.8 cases per 100,000 people.

The study released in June 2026 found the steepest jump was among men ages 18 to 29, though adults 30 to 49 had the highest overall rate.

In states that have not legalized sports betting, the rate moved in the opposite direction, falling from 3.1 per 100,000 in 2018 to 2.2 per 100,000 in 2026, a 29% decrease.

Some experts say expanded access to online sportsbooks and prediction markets are helping to drive gambling problems, particularly for younger users.

“As soon as you introduce a new form of gambling or dramatically increase the availability of gambling, you will be increasing the number of people that are experiencing harm because of that gambling,” Mark van der Maas, a Rutgers University social work professor who has studied the link between gambling and suicide, told NBC News.

More problems or better screening?

The American Gaming Association, a trade group that represents sportsbooks and other gambling companies, suggests that more diagnoses reflect better screening, not necessarily more addiction.

“While problem gambling is a serious condition for those impacted, this study does not indicate an increasing rate of addiction,” it said in a statement, per NBC. “Increased screening and greater awareness of available resources can often lead to more diagnoses, while decades of research have found no increase in problem gambling rates as legal gaming has expanded.”

The association said the industry invests around $500 million a year in education, research and support for those struggling with problem gambling.