Key Points
- The number of gambling disorder ER visits in Ontario is now up 99% from projections in Q2 2025, growing by 7% per quarter since market launch, without jumping right away as most believed.
- Young males between 10 and 29 accounted for gambling disorder ER visitation rates 154% higher than projections as of Q2 2025, while those between 30 and 44 were 116% higher than projections; no statistically significant change has been observed in females.
- Over 70% of gambling disorder ER visits were associated with other mental or substance abuse disorders, with 30% resulting in hospitalisation.
The province of Ontario began to regulate online gambling among the private sector in April 2022. In only three years, the number of patients admitted to the province’s emergency departments due to gambling disorders was already approaching twice what anybody had estimated.
The Climb Nobody Planned For
An epidemiological study recently published in the American Journal of Preventive Medicine found that during 14 years from 2012 to 2025, a population of more than 17.3 million Ontario citizens had 952 emergency department visits due to a gambling disorder, in which 757 patients were identified as the main or secondary reason. Almost 3/4 of those patients were men.
The average quarterly visit rate was 31.3% higher after market liberalisation than before. That figure alone would be concerning, but the more revealing finding lies in the shape of the trend. The rate did not spike sharply when Ontario’s private market opened. Instead, it built steadily, climbing at roughly 7% per quarter. By Q2 2025, observed visits were running 99% above the level projected from pre-liberalisation trends, with no sign of the curve levelling off before the study period closed.
Ryan Forrest, lead author and public health doctoral student at the University of Toronto, was precise about the demographic pattern: “The concentration of the increase among younger males is particularly concerning given the rapid growth and promotion of online sports betting, which target this demographic.”
Young Men, Acute Cases
Among males aged 10 to 29, ER visits were 154% higher than projected by mid-2025; among men aged 30 to 44, the rate was 116% above expected levels. Researchers found no statistically significant increase among women in either age group.
These presentations were severe. The ICES release confirmed that more than 70% of gambling-related ED visits involved another mental health condition or heavy substance use, and that almost one in three visits ended in hospital admission. Senior author Daniel Myran, Gordon F. Cheesbrough Research Chair at North York General and a scientist at ICES, was direct about what those hospital figures imply: “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.”
Researchers also noted a critical limitation: Ontario’s private market launch in April 2022 coincided with the wider rollout of legal single-event sports betting, which came into force under Bill C-218 in August 2021. The study measured their combined effect. Separating the contribution of each regulatory change was not possible with this data.
A Market at Record Scale
The context in which growth takes place is important. According to the iGaming Ontario 2024-25 Annual Report, gamblers gambled an amount of C$82.7 billion through private entities during the year 2024-25, which was 32% higher than the previous year. The total gaming income came to C$2.9 billion, representing a rise of 31% from last year. The casino offerings contributed an amount of C$2.2 billion to this gaming income, forming 75% of the total.
Heidi Reinhart, Chair of the iGaming Ontario Board, described the market plainly in that report: “With continued high rates of regulated play and $82.7 billion in total wagers in 2024-25, iGaming Ontario’s third year of operation has exceeded growth expectations.” The ICES data asks what accompanies those expectations.
Two Studies, One Direction
The ICES ER findings sit alongside a separate Ontario study, published in the Canadian Medical Association Journal in March 2026, which examined more than 745,700 contacts to ConnexOntario, the province’s 24-hour mental health and addiction helpline, from January 2012 to September 2025. Around 37,000 of those contacts were gambling-related.
Among men aged 15 to 24, the mean monthly rate of gambling-related contacts per million people rose by 317% from pre-market levels to the post-privatisation period; for men aged 25 to 44, the increase was 108%. The ICES team noted that helpline rates could, in theory, reflect improved awareness rather than worsening harm, since gambling advertisements are required to display helpline details. Emergency departments carry no such requirement and are not promoted through operator websites as a resource for gambling harm. Myran described the two sets of findings as “important complementary evidence” that, taken together, point in one direction.
Expert Analysis
We think the 7%-per-quarter compounding growth rate is the figure that regulators should be sitting with, more than the headline near-doubling. A trend that is still accelerating through the final data point is not a market finding its equilibrium; it is a signal that whatever structural conditions are driving harm have not yet met any counterforce.
The timing of this publication is pointed. Alberta’s regulated iGaming market officially launched on July 13, 2026, making it the second Canadian province to follow Ontario’s model. Myran addressed it in the ICES release: “Data from Ontario provide an important caution about the potential harms that can accompany rapid expansion of online gambling. 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.”
Whether Alberta’s regulators have built those safeguards in from the start, or whether they are watching Ontario’s ER trend lines closely enough, remains an open question. The Ontario data does not predict what happens in Alberta, but it does establish what happens when a market scales rapidly, with few friction points, in a province that is unprepared for the pace of harm that follows. That is a different kind of caution, and arguably a more useful one, than any headline figure.
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