Category: Health

Legalizing gambling can come with big health problems.

That’s the conclusion of a recent study out of Ontario, published in the American Journal of Preventive Medicine, which found that after the Canadian province legalized betting on individual sports events in 2022, emergency department visits for gambling disorders doubled. Most of the people who landed in the emergency department were men, and almost one third of the visits led to hospitalizations. 

“This rise in severe presentations might be a bit of a warning signal of a wider increase in harms across the general population,” says Ryan Forrest, a public-health doctoral student at the University of Toronto and one of the authors of the study. “We think about things like financial distress, family and relationship problems, worsening mental health—and those things are not captured in the emergency department data.” 

The authors of the Ontario study projected how many people would normally end up in an emergency department every year, and then compared that to what they saw after online betting on single sporting events became legal in Ontario. Emergency department visits were 154% higher than they would have been had the law not been changed, Forrest says. The visits were concentrated among men aged 10-44.  

Many of the patients showed up at the emergency room with major depression and suicidality, and some had other mental-health or substance-abuse diagnoses, Forrest said. Doctors at the emergency department noted in patients’ records that gambling had contributed to those other issues. 

A separate study by some of the same researchers also found that calls to ConnexOntario, Ontario’s free 24-hour mental health and addictions helpline, were 200% higher than they would have been had the law not been changed. That study found that the people reaching out for help were almost exclusively boys and men aged 15 to 44.

“There’s two data sources telling us there is a real health signal happening here,” Forrest says. 

The mental-health consequences of expanding betting

The study is a warning to the U.S., which has seen sports gambling proliferate since 2018 after the Supreme Court struck down a law barring most state-authorized sports gambling, allowing states to decide for themselves whether to allow sports betting. Since then, dozens of states, including New Jersey, Tennessee, and New York, have legalized sports betting. Many states also allow online casino games. Gambling has spread in Canada, too, after the country legalized betting on single sports events in 2021. 

Therapists in the U.S. say they are already seeing the mental-health consequences of the legalization of sport betting across the U.S., along with the results of more exposure to prediction markets. Birches Health, the largest provider specializing in the treatment of gambling disorder in the U.S., has seen the number of 18-to-34 year old clients grow more than twofold since 2024, according to Cynthia Grant, vice president of clinical for Birches Health. 

“There’s more people gambling,” she says, “and when you have more people gambling, it simply means that there’s more people who are going to develop a problem.” 

Grant says that clients are mentioning prediction markets 200% more often than they did last year, according to the company’s analysis of its initial clinical assessments. Prediction markets allow people as young as 18 to place wagers; sports betting is restricted to people over 21.

“It’s just not a regulated environment out there,” she says. “People’s lives are being ruined; their relationships are being destroyed, their retirement accounts are gone.” 

One of the reasons younger people are seeking treatment may be that they are starting to gamble earlier, she says. It’s not just prediction markets: some kids are given lottery scratch tickets for gifts, she says, or they’ll participate in family fantasy sports wages. “Those are the memories that people talk about” in therapy, she says. Kids are also exposed to gambling with online games that encourage them to chase a reward, or through hobbies like collecting Pokemon cards, in which they are betting that they’ll get a valuable card in an anonymous pack. 

The standard treatment for gambling disorder is cognitive behavioral therapy, Grant says, because people with a gambling addiction often have distorted thinking and believe that they can beat the system. But often, she says, people don’t even know that gambling disorder is a mental-health condition and that insurance can cover care. Studies show that suicidal ideation and suicide risk is 5 to 10 times higher in people with gambling disorders than in the general population. 

An under-regulated betting landscape

Both Grant and Forrest say that the unregulated nature of gambling in both Canada and the U.S. leads to more people ending up with mental-health problems—but that there is little investment in tracking those problems. There has been no money set aside by the Canadian government to track whether it leads to more public-health problems, Forrest says. 

“You compare that to something like when cannabis was legalized, there were huge amounts of grants given out to monitor these kinds of policy changes,” Forrest says.

Most apps don’t have automatic spending limits that prevent people from losing too much money gambling, and most take a hands-off approach to users who  act in a way that suggests they have an addiction. In a recent ProPublica story, a reporter posed as a problem gambler and found that rather than flagging his behavior, the app tried to incentivize him to keep going. 

“The way that online systems work right now do not protect people at all who are prone to behavioral addictions,” Grant says, “and that, to me, is very dangerous for my clients.” 

“Bartenders have rules about how much they can serve someone,” Grant says. “Police can issue a DUI—there are efforts to stop people who are potentially causing harm. But that does not happen in the gambling space.” 

Dr. Jonathan Tyes once struggled to imagine a future in medicine for himself. A first-generation college student and the oldest of 10 siblings, Tyes was raised by his grandparents in Cleveland. While studying biology at Morehouse College, he was a few credits from graduation when his grandmother died. Grief and financial hardship threatened to end both his education and his dream of becoming the first physician in his family. 

Instead, he spent years rebuilding his path. He worked throughout school, served those in need as a community health worker, completed medical mission trips to Ghana, became a registered pharmacy technician, and refused to abandon his goal of practicing medicine. Eventually, as a non-traditional student in his mid-thirties, he got into medical school. 

Though his family faced homelessness, gun violence, and other tribulations throughout his education, he stayed the course. Financial support from our organization, National Medical Fellowships (NMF), helped him remain enrolled and continue his training. Now, Tyes is an anesthesiology resident at the University of Buffalo, while at the same time pursuing a master of public health degree at Harvard.

His story is a testament to perseverance—but it is also a warning. America cannot afford to lose future physicians like Tyes. 

The health care workforce emergency that experts have warned about for years is no longer approaching—it is here. Over the next decade, the U.S. is projected to face a shortage of more than 700,000 health care professionals, including physicians, registered nurses, and licensed practical nurses. At the same time, countries such as Canada, Australia, New Zealand, Ireland, and the United Arab Emirates are actively recruiting U.S.-trained clinicians through streamlined licensing pathways, placing additional pressure on an already strained workforce. 

The consequences are being felt in every community. Whether you live in a rural town in Alabama or a high-rise in Manhattan, chances are you have experienced the shortage firsthand. You may have waited months for a pediatric appointment, spent hours in an emergency department hallway with an aging parent, or postponed care for your own chronic condition because the next available appointment was too far in the future. Today, the average wait time to see a physician is 38 days—nearly three times what many experts consider medically appropriate. 

Health care is built on people, yet the nation’s largest employment sector is buckling under the weight of burnout, mistrust, underinvestment, and the lingering effects of the COVID-19 pandemic. According to a recent Harris Poll, more than half of health care workers are considering leaving their jobs, with many planning to exit the profession altogether. Fewer than 17% of physicians are under the age of 40, while roughly one in five is over 60. 

The math isn’t adding up. We are losing experienced professionals faster than we are preparing the next generation. We are asking more of those who remain while offering them fewer resources and less support. Nowhere is this failure more visible than in rural and medically underserved communities. 

If we fail to address the root causes of this crisis—professional burnout, crushing educational debt, and declining reimbursement—we will not have a health care system capable of caring for our growing aging population, regardless of ZIP code or socioeconomic status. 

Yet instead of reinforcing the foundation, we are pulling bricks from the bottom. Federal health spending is being slashed. Programs that support research, expand access for low-income families, and strengthen public health infrastructure are being dismantled. Recent federal spending changes—including the passing of H.R. 1—are projected to increase the number of uninsured Americans, squeeze already fragile health systems, raise health care costs, and force community health centers and hospitals to shutter. 

The impact extends beyond today’s workforce to tomorrow’s. 

Changes to federal student lending that began in July 2026 will dramatically restrict access to financing for “professional” education. Medical students will face annual loan caps of $50,000, despite the fact that medical education costs exceed $286,000 at public institutions, on average, and approach $390,000 at private schools. Nursing students will face even tighter annual borrowing limits of $20,500, creating additional barriers to entering one of the nation’s most essential professions. 

These policies risk pushing brilliant students away from medicine, nursing, and other health professions altogether. They will discourage careers in primary care and hollow out the very specialties communities need most. 

And when we restrict who can afford to become a doctor or nurse, we ultimately restrict who gets cared for. 

A health care workforce that reflects a broad range of socioeconomic backgrounds and lived experiences is better equipped to understand patients, build trust, and improve outcomes. 

This moment demands collective action: We must reimagine pathways into health care careers, confront physician burnout head-on, and close the health and wealth gaps that weaken our system. We must prevent financial barriers from determining who has the opportunity to become a health care leader. 

And most importantly, we must ensure that the next generation of health care professionals receives the financial, professional, and community support necessary to complete training and return to serve the communities that need them most.