Legalized Sports Betting Linked to Surge in ER Visits and Mental-Health Crises in Ontario

Legalizing single-event online sports betting in Ontario was followed by a sharp rise in serious health problems, researchers report.

A study published in the American Journal of Preventive Medicine found that emergency-department (ED) visits for gambling disorders doubled after Ontario legalized betting on individual sporting events in 2022. The researchers estimate ED visits were 154% higher than would have been expected without the law change, and nearly one in three of those ED encounters resulted in hospitalization.

“This rise in severe presentations might be a bit of a warning signal of a wider increase in harms across the general population,”

says Ryan Forrest, a public-health doctoral student at the University of Toronto and a study coauthor. He noted that many related harms — financial distress, relationship breakdowns, and deteriorating mental health — are unlikely to appear in ED records.

The excess ED visits were concentrated among males roughly aged 10–44, while a separate analysis of calls to ConnexOntario, the province’s 24-hour mental-health and addictions helpline, found calls rose to about 200% of expected levels after the law change. That helpline increase was concentrated among boys and men aged 15–44.

Clinicians described many patients presenting with major depression, suicidal thoughts, and co-occurring substance-use or other mental-health conditions. Emergency-department notes often recorded that gambling had materially contributed to those presentations. Studies show suicidal ideation and suicide risk are five to ten times higher in people with gambling disorders than in the general population.

Providers in the U.S. report similar trends. Birches Health, the largest U.S. provider specializing in gambling-disorder treatment, says the number of clients aged 18–34 has more than doubled since 2024. Cynthia Grant, Birches Health’s vice president of clinical services, reports that references to prediction markets in initial assessments have risen sharply; prediction markets typically allow 18-year-olds to place wagers, while most sports betting is limited to those 21 and older.

Grant and other clinicians warn that many online betting platforms lack basic consumer protections: automatic spending limits, robust age verification, or systems that proactively flag risky behavior. A recent investigative report found some apps failed to identify or intervene with users who showed signs of problem gambling and in some instances actively promoted continued play.

Researchers and clinicians also point to a policy gap: governments in Canada and the U.S. have largely not funded independent, long-term public-health monitoring tied to the expansion of betting. Forrest contrasts this with cannabis legalization, which was accompanied by substantial public grants to study health and social effects.

What experts recommend: stronger regulations for online wagering platforms, mandatory spending and time limits, improved age verification, proactive risk-detection systems, and dedicated public funding for surveillance and treatment programs to track and mitigate harms.

While legal access to betting expands, the Ontario findings underscore an urgent need for prevention, monitoring, and treatment resources to reduce gambling-related harm, particularly among younger males.