ICES Study Published in the American Journal of Preventive Medicine Finds Ontario Emergency Department Visits for Gambling Disorders Nearly Doubled Following the August 2021 Federal Legalization of Single-Event Sports Betting and the April 2022 Opening of Ontario's Private Online Gambling Market, With the Largest Increases Concentrated Among Males Aged 10 to 29 and 30 to 44

Emergency department visits for gambling disorders in Ontario ran 99 per cent above the expected pre-legalization baseline after the federal government legalized single-event sports betting in August 2021 and Ontario opened its private online gambling market in April 2022, according to a peer-reviewed study published Wednesday, September 16 in the American Journal of Preventive Medicine by researchers at ICES and the University of Toronto's Dalla Lana School of Public Health. The increases were concentrated in boys and men aged 10 to 29, where visits were 154 per cent higher than expected, and in males aged 30 to 44, where visits were 116 per cent higher. No significant change in gambling-related emergency department presentations was observed among females across the same period.

The study, titled "Emergency department visits for gambling disorders after the legalization of single-event sports betting and rapid expansion of online gambling," analyzed 952 gambling-related emergency department visits made by 757 individuals in Ontario between January 2012 and September 2025, using administrative health data held at ICES. The findings are the latest, and clinically the most direct, in a growing body of Canadian population-health research examining what has happened to gambling-related harm indicators since the federal Criminal Code amendment on single-event sports wagering (Bill C-218) received Royal Assent in June 2021 and took effect on August 27, 2021, and since Ontario became the first Canadian province to open a competitive private online gambling market on April 4, 2022.

What the Authors Said

Ryan Forrest, a public-health doctoral student at the Dalla Lana School of Public Health and the study's first author, told a Toronto press briefing on Wednesday morning: "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. The consequences of rising gambling involve not just harm to people who are gambling but wider effects on families and communities," per the study release carried by EurekAlert.

The senior author, Daniel Myran, an ICES scientist, Gordon F. Cheesbrough Research Chair in Family and Community Medicine at North York General, and an associate professor with the University of Toronto's Department of Family and Community Medicine, said: "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." Speaking to the Globe and Mail in a follow-up interview, Myran added: "It makes me worry about a public-health crisis. The reaction I had on first seeing these numbers is, this is really bad."

Methodology and Scope

The study uses an interrupted time-series design, comparing observed monthly counts of Ontario emergency department presentations coded for gambling disorders against a counter-factual trend extrapolated from the pre-legalization period. The 99, 154 and 116 per cent figures are the percentage differences between observed rates at the end of the study period and the modelled expected rates in the absence of the 2021 and 2022 policy changes. Emergency department visits are drawn from the National Ambulatory Care Reporting System, the standard Canadian ED dataset held at ICES for Ontario. The authors describe the outcome as a "sensitive but non-specific" indicator of severe gambling-related harm: an emergency department visit for a gambling disorder is a clinical event that requires the presenting problem to be significant enough to trigger acute care, and the coding rules for gambling disorder are conservative.

The full author list is Ryan Forrest, N. Doan, R. MacDonald-Spracklin, M. Pugliese, N. Turner and Daniel T. Myran. The paper carries the digital object identifier 10.1016/j.amepre.2026.108551 and appears in the September 2026 issue of the American Journal of Preventive Medicine, per the ICES publications record.

Companion Helpline Study

The emergency-department findings sit alongside a companion population-health study published earlier this year by Forrest, Robert Talarico, Anosha Waqar and Myran in the Canadian Medical Association Journal, indexed on PubMed. That earlier study, titled "Help-seeking for gambling problems following expansion of online gambling and legalized single-event sports betting in Ontario, Canada," found that the rate of young men contacting Ontario's mental-health helpline for gambling-related problems rose by more than 300 per cent after the province opened its private online gambling market, and concluded that "the introduction of online gambling and subsequent privatization with single-event sports betting were each associated with substantial increases in gambling-related helpline contacts, specifically in adolescent boys and young men, suggesting increased gambling problems, care-seeking, or both. This underscores the need to strengthen preventive measures and treatment access." The two studies together document the same demographic signal at two very different points on the harm severity spectrum, telephone help-seeking and hospital-level acute care.

Where the Ontario Market Stands Today

The regulated Ontario iGaming market, run by the Alcohol and Gaming Commission of Ontario (AGCO) and iGaming Ontario, launched on April 4, 2022 as the first Canadian competitive private online gambling market. As of the August 2026 AGCO directory the province is home to 48 registered operators running 83 licensed gaming websites across online casino, sports betting, poker and bingo products, per operator directory reporting. In its fourth annual reporting period the market recorded CA$9.9 billion in total cash wagers in July 2026 alone, up 30.7 per cent year-on-year, with 1.365 million monthly active player accounts, per iGaming Ontario's monthly market performance data reported by CDC Gaming. Online casino products, not sports betting or poker, account for 89 per cent of total cash wagers and 80 per cent of non-adjusted gross gaming revenue.

The Peer-to-Peer Poker Segment in Context

Peer-to-peer online poker is a small share of the Ontario iGaming market by wagering handle. iGaming Ontario reports poker as a distinct product category alongside online casino and online sports betting; poker sits inside the online casino share for reporting purposes and is not broken out in the monthly release. As of September 2026 there are two AGCO-registered peer-to-peer poker platforms in commercial operation on the ring-fenced Ontario network: GGPoker Ontario, which launched in 2022, and PokerStars on FanDuel Ontario, which relaunched under FanDuel infrastructure in June 2026. A third operator, ClubWPT Gold, is expected to enter the Ontario market later in the year.

The ICES study does not disaggregate the gambling disorders identified in the emergency department data by product category. The authors do not report, and administrative ED coding does not capture, whether a given gambling-related presentation is linked to online casino play, sports wagering, poker, retail gaming or lottery. What the study documents is the aggregate direction of clinical harm in the years following the two 2021 and 2022 policy changes, in the demographic subgroup that has borne almost all of the increase.

Where to Get Help in Ontario

Ontario residents concerned about their own or a family member's gambling can contact ConnexOntario, the province's mental health, addictions and problem-gambling helpline, twenty-four hours a day at 1-866-531-2600, or through the ConnexOntario web-chat and text services. The helpline is free, confidential and available in multiple languages. The AGCO's PlaySmart program provides Ontario-specific responsible-gambling information and tools including deposit limits, session-time limits and self-exclusion. AGCO-registered operators, including the two peer-to-peer poker platforms, are required to offer province-wide self-exclusion through PlaySmart's centralized register and to display responsible-gambling messaging inside their gaming interfaces.

Editor's Note

OntarioPoker.com is a New World Gaming Limited publication that covers the regulated Ontario poker market. We take the ICES findings seriously. Peer-to-peer poker is a small component of the Ontario iGaming market by handle and is not the demographic centre of the harm signal documented in the Forrest et al. study, which is a signal about young male sports and casino gambling. We report the findings in full because Ontario poker players are Ontario iGaming customers and are entitled to the province's public-health research about the market they participate in. Where our own coverage relates to product launches, promotions or bonuses, our editorial standards require responsible-gambling messaging in every review and every promotional article.

Reporting draws on the September 16 ICES press release carried on EurekAlert, the Institute for Clinical Evaluative Sciences publications record, the Globe and Mail's coverage of the study, PubMed indexing of the companion CMAJ paper, iGaming Ontario monthly market performance releases as reported by CDC Gaming, and the AGCO operator directory. The study reference is Forrest R, Doan N, MacDonald-Spracklin R, Pugliese M, Turner N, Myran D. "Emergency department visits for gambling disorders after the legalization of single-event sports betting and rapid expansion of online gambling." Am J Prev Med. 2026 Sep 16. doi:10.1016/j.amepre.2026.108551. Illustration is AI-generated for editorial purposes. If you or someone you know is affected by gambling harm, contact ConnexOntario at 1-866-531-2600, twenty-four hours a day, free and confidential.