<p>This paper examines the impact of legalizing full-scale casino gaming on drug-related offenses in Hot Springs, Arkansas. While the state’s other casino-hosting cities—Pine Bluff and West Memphis—and the state of Arkansas as a whole have experienced a recent decline in drug-related offenses, Hot Springs has seen a notable increase. This research utilizes the synthetic control method to analyze city-level data from 2011 to 2024, comparing Hot Springs to a counterfactual “synthetic” city. This counterpart is constructed from a weighted combination of non-casino Arkansas cities, matched on pre-existing crime trajectories and socioeconomic predictors. Our findings indicate that Hot Springs experienced a statistically significant increase in drug arrests following the transition to full casino gaming in April 2019. By 2023 and 2024, the drug arrest rate in Hot Springs was approximately double that of its synthetic counterpart. We conclude that the social costs of gaming expansion are context-dependent. In Hot Springs, the increase may be driven by its status as a growing resort destination, where a high volume of transient visitors creates an anonymous environment conducive to illicit transactions.</p>