Gambling disorder ED visits double in young men

Clinical takeaway: Severe gambling harm is rising in men under 45. Most never seek help, so a mood or substance complaint may be the only opening to ask. 

Sports betting has spread across the US since the Supreme Court cleared the way in 2018, moving onto phones and into a market that advertises hardest to young men. But the proliferating harms are rarely self-identified as tracing back to gambling. Patients seldom raise it and stigma keeps most who need treatment from ever seeking it. Gambling disorder presents alongside depression, substance use, and suicidality, any of which can surface during a visit. 

Ontario ran a version of the same expansion as a single province-wide switch starting in April 2022, making it an unusually clean test of what follows. Until now the evidence has been indirect: internet searches and helpline calls rose after markets opened. A new Ontario analysis tracks a measure harder to inflate: emergency department visits for gambling disorders, before and after the province legalized single-event sports betting and opened online gambling to private operators. 

By mid-2025, three years after the switch, emergency visits for gambling disorders were running 99% higher than expected had the market stayed closed. The increase was entirely among younger men. Visits ran 154% above expected in males aged 10 to 29 and 116% above expected in males aged 30 to 44, while rates in women did not change. Rates had been flat for the eight years before the pandemic, did not jump when the market opened, and then climbed about 7% per quarter from launch onward. 

These visits were a small share of ED visits, but were rarely simple. Quarterly rates remained under two visits per million residents throughout, yet 72% carried a mental health or substance co-diagnosis, and 31% ended in hospital admission. Cocaine co-diagnoses rose from 2% of visits before the expansion to 14% after. 

The study covered all 17.4 million Ontario residents aged 10 and older under universal health coverage from 2012 through mid-2025. An interrupted time series compared visit rates before and after the April 2022 market opening, with pandemic quarters censored. Over 14 years, 757 people accounted for 952 visits with a gambling disorder recorded as a main or contributing reason. 

Alberta opened its own private online gambling market in July 2026, other provinces are weighing the same move, and most US states now run legal sports betting markets that have never been evaluated this way. The authors argue that jurisdictions expanding access should pair it with marketing restrictions, limits on higher-risk formats like in-play microbetting, and better treatment access for the patients already presenting. 

"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," says senior author Daniel Myran, MD, MPH, associate professor in the Department of Family and Community Medicine at the University of Toronto. 

Source: Forrest R, et al. (2026 Sep 16) Am J Prev Med. Emergency department visits for gambling disorders after the legalization of single-event sports betting and rapid expansion of online gambling