Sixty-three people have died in butane inhalation-related incidents since 2000 and Chief Coroner Judge Neil MacLean said it was hard to see what action the Government had taken in response to numerous coroners' recommendations to stem the toll.
A multi-agency response to the problem was urgently needed, with the Ministry of Social Development taking the lead and the Ministries of Justice and Health also involved.
"This is an insidious and extremely dangerous activity that is predominantly killing young males," he said.
Judge MacLean launched an an urgent review into the practice after two Mosgiel teenagers were critically injured in July when an LPG cylinder they were believed to have been huffing from exploded.
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 past 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.
