Online Sports Betting Legalization and Prescriptions for Mental Health and Substance Use Medications

• In Event: The Spread: Sports Betting Legalization Spillovers Into Financial, Health, and Education Outcomes

Abstract

Since 2017, the number of states with legalized online sports betting increased from one to 31. As of 2025, half of men aged 18–49 have an online sports betting account. Studies using survey data have linked sports betting legalization to increases in self-reported poor mental health and binge drinking among young men; however, little is known about the downstream impact on mental health and substance use treatment utilization. This study evaluates the effect of online sports betting legalization on prescriptions for antidepressants, anti-anxiety medications, and substance use disorder (SUD) medications among young men.

Given the staggered nature of legalization across states, we use the Callaway and Sant’Anna difference-in-differences and event study estimator to identify the effect of online sports betting legalization on the probability of an 18–49-year-old male being prescribed antidepressants (e.g., selective serotonin reuptake inhibitors), anti-anxiety medications (e.g., benzodiazepines), and SUD medications (e.g., naltrexone). All models are estimated at the individual-year level. As placebo tests, we evaluate the effect of legalization on prescriptions for antibiotics and diabetes medications, which we do not expect to be related to sports betting laws.

We use MarketScan commercial claims data from 2015 to 2023. Our sample includes commercially insured men aged 18–49 from 22 treated states that legalized online sports betting between 2018 and 2022, and 23 control states that either never legalized or legalized later than 2023. We exclude states that legalized during 2023 due to an insufficient follow-up period. Our final sample includes 26,673,038 enrollee-years.

On average, 9.3% of enrollees had a prescription for an antidepressant in a year during our study period, while 5.6% and 0.5% had prescriptions for anti-anxiety and SUD medications, respectively. We find that online sports betting legalization increased the proportion of enrollees taking antidepressants by 5.5% (0.51 percentage points [pp], 95% confidence interval [CI]: 0.18–0.84), increased the proportion taking anti-anxiety medications by 5.0% (0.28 pp, 95% CI: 0.09–0.48), but had no detectable effect on the proportion taking SUD medications (-0.01 pp, 95% CI: -0.04–0.02). Event study analyses indicate no evidence of differences in prescription trends prior to legalization. Our placebo test event studies suggest no evidence of sports betting legalization affecting antibiotic and diabetes prescriptions. Altogether, our results suggest that state legalization of online sports betting may increase the number of young men taking antidepressants and anti-anxiety medications.

Several years into the legalized online sports betting era, states need holistic assessments of their laws’ societal effects beyond the tax revenues they generate. Our findings suggest that online sports betting legalization may have negative mental health consequences for commercially insured young men, with some costs borne by insurers and employers through increased prescription drug utilization, an externality that partially offsets gains to state budgets. Because our data cover only the commercially insured, these estimates likely understate the full population impact, which also extends to Medicaid enrollees and the uninsured. As additional states contemplate legalization and regulation, these findings underscore the importance of weighing public health consequences alongside direct fiscal benefits.

Author

• Benjamin Westermeyer, Johns Hopkins University
  Presenting Author