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After the privatization of online gambling in Ontario, including expanded single-event sports betting offerings and heavy advertising, contacts to Ontario’s mental health helpline for gambling-related problems increased 317% in men and adolescent boys aged 15 to 24 years and 108% in men aged 25 to 44 years, according to new research published in CMAJ (Canadian Medical Association Journal).
“These findings suggest a population-level rise in gambling problems, help-seeking behaviour, or a combination, coinciding with the widespread availability and marketing of online betting,” writes Dr. Daniel Myran, Gordon F. Cheesbrough Research Chair in Family and Community Medicine, North York General, and a scientist at ICES and the Bruyère Health Research Institute, with coauthors.
Online gambling has recently undergone enormous expansion in Canada and the United States. To evaluate expanding access to online gambling in Ontario, Canada’s largest province, the researchers tracked monthly contacts to ConnexOntario — Ontario’s 24-hour free mental health and addictions helpline — between January 2012 and September 2025.
Online gambling was first offered in Ontario starting in January 2015 through a government-run platform, PlayOLG, with online lottery, casino, and instant games. In 2021, the federal government amended the criminal code to legalize single-event sports betting across Canada. In April 2022, Ontario became the only province to open a competitive private online gambling market, allowing companies to offer and heavily advertise online casino games and single-event sports betting alongside the government platform.
By 2024, Ontario’s legal gambling market included 80 gaming and betting sites operated by 49 private companies, including some of the world’s largest multinational gambling corporations. In that year alone, $63 billion was wagered on these sites through 2.1 million player accounts.
To determine the potential health effects of online gambling, the researchers divided the study into 4 periods: before PlayOLG (January 2012 to December 2014), post–PlayOLG launch (January 2015 to February 2020), the COVID-19 pandemic period (March 2020 to March 2022), and after expansion to private sector companies, which included single-event sports betting (April 2022 to September 2025).
Key findings:
- A total of 745 716 helpline contacts occurred during the study period, of which 37 087 (5%) were gambling related.
- During the period following online gambling privatization and legal sports betting (2022 to 2025), 9.2% of total helpline contacts were gambling related, and 76% of gambling contacts were for problems with online gambling.
- Total legal monthly wagers increased 654% between April 2022 and August 2025, and active player accounts for people aged 15 and older increased 239%.
- Gambling-related contacts increased overall by 96% over the study period.
- Increases occurred almost exclusively in men, with visits increasing by 317% in those aged 15 to 24 years and 108% in those aged 25 to 44 years.
“The increases occurred almost exclusively among men aged 15 to 44 years, the group at highest risk of online gambling-related harms and the primary target of gambling and sports betting marketing,” said Dr. Myran.
The authors suggest that other parts of the country that are considering allowing privatized online gambling may want to think twice.
“Ontario is the only province that allows private operators, including many large multinational companies, to offer online gambling,” said coauthor Ryan Forrest, a public health doctoral student at the Dalla Lana School of Public Health at the University of Toronto. “This move has vastly expanded gambling advertising and opportunities to gamble and may be allowing access to higher-risk forms of gambling. Given the increases in health harms we documented, our study cautions against similar expansions in other provinces.”
Last fall, a CMAJ editorial, Protecting Canada’s youth from the risks of exposure to gambling advertising, raised the alarm about the harm from sports betting advertising on children and young adults.
“Gambling is an underrecognized determinant of health, and these results highlight the urgent need for stronger prevention measures. At a minimum, governments across Canada should immediately act to restrict gambling advertising — which has proliferated since legalization — and to place limits on gambling types known to be most addictive, like in-play sports betting. The scale of the increases also suggests that much greater access to treatment and supports may be needed,” Forrest concludes.
Expert Reaction
These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.
Simone Rodda, Associate Professor in Psychology and Neuroscience at AUT University
"Perhaps the key message from the article is that Gambling Helpline and each of the treatment services with phone help would expect to see increases in calls fairly soon after the new online casinos are launched in NZ.
"This is a typical pattern when more people gamble, more people experience problems and reach out for advice or support.
"Treatment services in NZ are currently underprepared for the potential influx of callers both in terms of funding for additional staff and professional development in how to respond to the specific risky features of the new casinos.
"A key issue is that we won’t know about the specific risky features until they are up and running and if there is a lag with identifying them then unaddressed harm can accumulate fairly quickly. We do know that the casinos will include the riskiest form of gambling – poker machines.
"Communities need advance warning of what will be in each casino and how they will operate before they are launched. Communities also need to know the timing of each go-live date so that they can be prepared to meet and mitigate potential harm."
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