Last month, 17-year-old Poihaere Eru died in Christchurch after apparently huffing butane with two friends.
Judge MacLean said most of the youths who huffed were at a "real loose end".
"They're kind of a lost generation in a way."
He said deaths from huffing were random.
"Users can die on the first time they ever use it, or the 50th or the 100th and there's no way of guaranteeing safe use."
Most huffing cases involved common household butane cans, and it would be difficult to restrict sale of those, he said.
In the last 12 years, coroners had made numerous recommendations to the Government, including a public education campaign, introducing nationwide substance abuse centres, specialist drug training for teachers and regulating the availability of products that could be abused.
All the recommendations should be taken up by the Government, he said.
In 2010, 16-year-old Nikora Mikaere Harepaati Birch, who was also known as Nick O'Neill, was found dead on the banks of a stream in Wainuiomata, near Wellington.
An empty can of butane was found lying next to him and in the days before his death, a friend said he had been sniffing a can of butane gas daily.
Recommendations to the Ministry of Social Development were made by a coroner in that case to take a fresh look at reducing ways of supplying butane as well as reviewing the policing of volatile substance abuse.
The ministry's response was that the problem was a joint responsibility across government and "the encouraging thing is that there is a lot happening in this space at the moment".
Judge MacLean said there was no comment into exactly what was happening. In fact there had "never been a formal response to [any] recommendations".
He acknowledged it was an "extraordinarily hard problem" where there were no easy answers.
His review looked at other countries - such as North America, Australia, Canada and the United Kingdom - and New Zealand did not compare well in in terms of preventing huffing deaths.
"We can hardly hold our hand up and say we're leading the charge on dealing with this. We're not," Judge MacLean said.
Minister of Health Tony Ryall said he had not read the report.
Social Development Minister Paula Bennett was not convinced her ministry should lead the response.
"The answers lie across government and communities - but as far as a response from government; it's not really in the Ministry of Social Development's area of responsibility. We can't tell retailers what to do.''
Associate Minister of Health Peter Dunne said retailers should take some responsibility.
"Young kids coming in to buy substances of this type should raise suspicion.''
Child and Youth Mortality Review Committee (CYMRC) chairman Nick Baker said a co-ordinated approach across many sectors was needed to prevent injury in young people.
"Preventing these deaths requires work to reduce both the supply of and demand for these poisonous substances. This includes reducing sales and access to butane-based products, voluntary control of butane by retailers, educating providers of support services to young people, community education strategies, strengthening individual knowledge and skills among youth, and providing access to quality health care,'' Dr Baker said.
The committee would be releasing a report on unintended poisonings in the coming months. "The coroner's findings align with the preliminary findings in our report,'' he said.
The committee operates under the Health Quality & Safety Commission and reviews the deaths of children and young people.
