Rising rates of opioid use disorder, overdoses, and opioid-related criminal offenses have prompted U.S. law enforcement agencies to adopt alternatives to arrest and formal criminal processing. Police departments frequently implement treatment referral programs and claim an affiliation with the Police Assisted Addiction and Recovery Initiative (PAARI). Although expanding to hundreds of agencies, PAARI efforts may not be equally distributed across communities, raising concerns about access to non-arrest diversion and increasing disparities in the criminal processing of drug-related offenses. This study compares the characteristics and geographic placement of law enforcement agencies with and without PAARI programs in 29 states. Law enforcement agencies situated in communities with lower rates of poverty and smaller Black populations have lower odds of having a PAARI program. Agencies based in counties with more overdose deaths and greater unmet treatment needs have increased odds of deflection programing. This placement of PAARI programs reflects broader inequalities in criminal justice and health. More advantaged, predominantly white communities benefit from diversionary programs while fewer alternatives to formal criminal processing exist for lower-income areas and communities of color. Additional research should explore these growing disparities in the deployment of law enforcement-based treatment referral programs and their consequences on drug law enforcement.