(1) To determine whether dexamethasone administration reduced narcotic consumption during hospitalization and (2) to evaluate if patients who received dexamethasone refilled fewer opioid prescriptions postoperatively. We retrospectively identified all adult patients who underwent primary elective 1-4-level ACDF at a single center. Prescription opioid use was collected from governmental online prescription drug monitoring programs and in-hospital opioids were collected from each patient's medication administration record and recorded as milligrams of morphine equivalents (MMEs). Patients were categorized by whether or not intravenous dexamethasone was administered perioperatively. Dexamethasone protocols were considered high dose if weight-based dosing was >0.20 mg/kg and low-dose if <0.20 mg/kg Multivariable linear regression was conducted accounting confounders to assess the relationship between dexamethasone administration and MME prescribed at each time point. We included 249 patients, 167 (67%) of whom were administered dexamethasone. Patients in both groups utilized a similar quantity of opioids while hospitalized (no dexamethasone: 56.7 vs. dexamethasone: 39.4 MME/day, p=0.3499). Patients in both groups refilled a similar quantity of opioids in all postoperative time periods; 0-3 week (3.38 vs. 4.07 MME/day, p=0.5277), 3-6 week (0.36 vs. 0.75 MME/day, p=0.1979), 6-12 week (0.53 vs. 0.75MME/day, p=0.9000), and 3-month to one-year (0.28 vs. 0. MME/day, p=0.5310). On multivariable linear regression, dexamethasone was not associated with a reduction in opioid volume at any time point (all p>0.05). Administration of perioperative dexamethasone does not reduce in-hospital or home opioid usage regardless of weight-based dose. Analgesia should not be the primary driver of dexamethasone administration for ACDF.