Take something as simple as a vector (eg. std::vector in C++). If a user directly sets the size or capacity, the calls to methods like push_back() will behave incorrectly, or may even crash.

Opaque pointers are one way of hiding representation, but they also eliminate the possibility of inlining, unless LTO is in use. If you have members that need to be accessible in inline functions, it's impossible to use opaque pointers.

There is certainly a risk of "implicit interfaces" (Hyrum's Law), where users break even when you're changing the internals, but we can lessen the risk by encapsulating data structures as much as possible. There are other strategies for lessening this risk, like randomizing unspecified behaviors, so that people cannot take dependencies on behaviors that are not guaranteed.