Ontario’s expansion of online gambling and legalization of single-event sports betting were followed by a sharp rise in help-seeking for gambling problems, particularly among young men. A new CMAJ study, Help seeking for gambling problems following expansion of Ontario's online gambling market and legalization of single event sports betting, analyzes calls to Ontario's 24-hour mental health and addiction hotline before and after the 2022 policy changes. The findings suggest that increased accessibility, private-sector expansion, and in-play betting may be amplifying gambling-related harm.

Dr. Daniel Myran, a family physician, research chair in family and community medicine at North York General Hospital, and co-author of the study, reports that hotline contacts among males aged 15 to 24 tripled after the market opened to private operators. By the end of the study period, more than 70% of callers cited online gambling. He describes how legalization of single-event sports betting and in-play betting reduced friction and increased immediacy, features linked to higher addiction risk.

Dr. Daniela Lobo, medical lead of the Problem Gambling and Tech Use Clinic at CAMH and an assistant professor of psychiatry at the University of Toronto, describes seeing younger patients since the introduction of iGaming, including individuals in their late teens and early twenties. She explains how in-play betting mirrors other high-risk formats by offering rapid, repeated opportunities to wager. Gambling disorder shares features with substance use disorders, including tolerance, withdrawal symptoms, concealment, financial strain, and suicidal ideation. She also highlights medication-related risk, noting that dopamine agonists and certain atypical antipsychotics have been linked to new gambling behaviours.

Clinicians should consider gambling when patients present with unexplained financial stress, relationship conflict, mood symptoms, or suicidality, and remain alert to medication-induced behavioural change. Resources like ConnexOntario offer anonymous referral support for patients and providers.

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High stakes: Online gambling and the rise in harm

CMAJ Podcasts

High stakes: Online gambling and the rise in harm