This population-based interrupted time series study examined changes in emergency department (ED) visit rates for gambling disorders among all Ontario residents aged ≥10 years (N=17,353,640) before and after the legalization of single-event sports betting and privatized online gambling in April 2022, tracked from January 2012 to June 2025.
Over 14 years, 952 ED visits for gambling disorders occurred (757 unique individuals; mean age 41.8 years; 72% male); after liberalization, overall quarterly rates rose 31.3% (1.28 to 1.68 per 1,000,000), increasing by 7% per quarter (IRR=1.07, 95% CI 1.04–1.10), and reaching ~99% higher than expected by April–June 2025 (IRR=1.99, 95% CI 1.48–2.67)—driven entirely by young males (ages 10–29: IRR=2.54; ages 30–44: IRR=2.16), with no increase in females.
ED visits represent only the most severe gambling disorder cases, likely undercounting the true burden of gambling harms in the general population; the study cannot establish causation between gambling liberalization and increased visits, as other concurrent societal factors may have contributed; and the results from Ontario, Canada may not generalize to other jurisdictions with different gambling regulatory environments.
Clinicians—especially those in emergency settings—should be alert to gambling disorder presentations in young men, as ED visit rates roughly doubled following online gambling expansion; routine screening for gambling harms in this demographic is warranted, particularly in regions where online and sports betting have recently been legalized.
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